‘Development and evaluation of primary care interventions is urgently warranted to tackle the harm associated with AKI’

‘Development and evaluation of primary care interventions is urgently warranted to tackle the harm associated with AKI’ - States CLAHRC GM’s Latest Research Paper

Leading online medical research journal, BMJ Open, has published NIHR CLAHRC Greater Manchester’s latest paper on the role of sick day guidance cards in helping to prevent Acute Kidney Injury (AKI) - a sudden reduction in kidney function - through primary care services. Sick day guidance is well established in the management of long-term conditions, particularly diabetes, and is used to support people to self-manage during times of acute illness. However, the concept has only recently been applied to the prevention of AKI as certain commonly-prescribed medicines, such as those used to treat vascular disorders, can contribute to developing the condition during times of acute illness. As such, medicines management-focussed sick day guidance interventions have been designed to guide people through temporarily stopping taking medicines during times of acute illness to help prevent AKI.

The research paper, ‘Understanding the implementation of ‘sick day guidance’ to prevent Acute Kidney Injury across a primary care setting in England: a qualitative evaluation’, focusses on the findings of a study of a sick day guidance intervention, carried out in a primary care setting in Greater Manchester. Consisting of a small card for patients, providing advice on the temporary cessation of certain medicines, the intervention was rolled-out in general practices and community pharmacies across one CCG area.

The research team undertook a qualitative, process evaluation of the interventions implementation, from professional and patient perspectives; this paper highlights their key findings, which were:

• The concept of ‘temporary cessation of medicines’ - that is, stopping taking medicines for a time, can be a challenging one to communicate to patients. Patients may interpret illness symptoms or their severity, in different ways, or may be taking several different medicines.
• There was akey tension between working to distribute the cards across the relevant/large population and ensuring that patients understood how to use them correctly; professionals and patients agreed that dialogue was needed to explain the cards, but finding time to do this was often difficult.
• Sick day guidance cards that focus solely on medicines management may be of limited patient benefit without adequate resourcing, or if delivered as a standalone intervention.

The research paper concludes that the development and evaluation of primary care interventions is urgently warranted to tackle the harm associated with AKI.  The full evaluation report for the study was published earlier this year and its findings support the statement from Think Kidneys – the national campaign to raise awareness of kidney health – which indicates a more robust evidence base is required concerning the effectiveness of sick day guidance.  You can find out more here.

Date Published: 13/11/2017