A Dual-centre, Two-arm, Open-label Randomized Controlled Trial Comparing an Integrated Collaborative Nurse-led Physician-supported Multimorbid Chronic Kidney Disease Care Model Versus Physician-led Care (INTEGREAT-CKD)
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 220
- 试验地点
- 1
- 主要终点
- Chronic Kidney Disease Self-Management (CKD-SM) Questionnaire
研究概览
简要总结
Chronic kidney disease (CKD) is a prevalent chronic disease and is often intertwined with the management of cardiovascular disease and the optimization of metabolic risk factors. In light of steeply rising rates of end-stage kidney disease (ESKD) and increased healthcare resource utilization by CKD patients, the investigators propose that the role of nurses could be expanded to support the care of CKD patients in the community.
A total of 220 patients will be randomized (1:1) to the intervention or control groups (usual care). The intervention entails enrolment into a nurse-led, physician-supported programme (INTEGREAT-CKD), comprising outpatient consultations and community-based ambulatory monitoring and counselling primarily driven by CKD-trained advanced practice nurses (APNs) and healthcare professionals conducted over 6 months. Patient-reported outcomes like health-related quality of life (HRQOL), as measured by EQ-5D and KDQOL, CKD self-management score and CKD health literacy will be assessed at baseline and after 6 months. The primary outcome is CKD self-management. Other secondary outcomes to be assessed and tracked including achievement of clinical targets relevant to slowing down CKD progression, attainment of CKD best practice guidelines as specified in the KDIGO CKD Evaluation and Management guidelines 2020.
详细描述
Study objectives:
- To evaluate if a nurse-led model of care (INTEGREAT-CKD), in comparison to the standard of care (physician-led care), improves self-management skills, quality of life, and health literacy in patients with advanced CKD.
- To assess if a nurse-led physician-supported consultation model of care, in comparison to the standard of care, optimizes the attainment of clinical targets following CKD best practice guidelines.
- To assess if health resource utilization is cost-effective for complex CKD patients cared for by a nurse-led physician-supported consultation model of care compared to the standard of care.
Study design This study is a dual-centre two-arm, open-label randomized controlled trial (RCT). Patients are randomized with a one-to-one allocation into two parallel groups. Participants with advanced CKD referred to the tertiary institutions are randomized to either the control group (physician-led standard of care consultation model) or the experimental (intervention) group, which consists of enrolment in the INTEGREAT-CKD programme. INTEGREAT-CKD is a six-month programme consisting of an outpatient nurse-led consultation model, delivered by a team of CKD-trained Advanced Practice Nurses (APNs) and community-based nurses. Participants are reviewed in person at a 3-monthly interval by a CKD-trained APN independently. The CKD-trained APN's practice is supported by adherence to a protocol-based and algorithmic set of guidelines co-written by the CKD-trained APN and nephrologist for the main clinical aspects of CKD care. Each clinic session is allocated an extended duration of 30 minutes to educate patients on CKD-related medical knowledge, targeted lifestyle modification, and self-management skills. Questionnaires to determine patient's health literacy, self-management skills, and quality of life are assessed at the beginning and end of the study.
Setting:
The study will be conducted across two tertiary hospitals, Alexandra Hospital (AH) and National University Hospital (NUH), located in the western cluster of Singapore. Both hospitals are tertiary healthcare institutions that receive outpatient nephrology consult referrals, including consultation about CKD management, from within the institutions and primary healthcare sector within the western cluster.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 21 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adults aged 21 years and above AND diagnosed with
- •CKD Stages 3B and above (defined as estimated GFR less than or equal to 44 mL/min/1.73m2 with evidence of kidney damage) AND diagnosed with
- •one or more of the following sub-optimally managed parameters pertaining to blood pressure control OR, glycemic control OR fluid status management.
排除标准
- •Pregnancy
- •End stage kidney disease
- •Enrolment in any structured outpatient-based or community-based CKD program for at least six months prior to or during the period of enrolment in the study.
- •Dementia and/or cognitive impairment
研究组 & 干预措施
Control group
Control arm: Patients will be assigned to a consultation model of CKD care which consists of clinic reviews by a nephrologist, which is as per current standard of care. The frequency of reviews, which is at the discretion of the nephrologist, is typically scheduled at 4 to 6 monthly intervals. Each consultation lasts an average of 10 to 15 minutes.
INTEGREAT-CKD Intervention
Intervention arm: Patients will be assigned to a consultation model of CKD care which consists of 30-minute clinic reviews led by an advanced practice nurse (APN), with both on-site and remote support from a nephrologist, at 3 monthly intervals. Patients will be required to monitor certain clinical parameters (one of or a combination of blood pressure, glucose trend or weight trend) between clinic reviews, tapping on a telehealth platform for transmission of data to an assigned community-based nurse, who will provide oversight of these readings, with regular escalation to the APN/nephrologist. The on-site remote support, in the form of telehealth monitoring, will be concurrent between clinic consults, with frequency of monitoring individualized as per patient's needs.
干预措施: INTEGREAT-CKD Intervention (Other)
结局指标
主要结局
Chronic Kidney Disease Self-Management (CKD-SM) Questionnaire
时间窗: 24 weeks from participants' date of enrollment
Patients will be scored based on their questionnaire responses and the primary outcome is the improvement in the CKD-SM score. Baseline scoring is done during enrolment.
次要结局
- Secondary outcome(24 weeks from participants' date of enrollment)