ArticleBMJ open2016
What drives quality improvement in chronic kidney disease (CKD) in primary care: process evaluation of the Quality Improvement in Chronic Kidney Disease (QICKD) trial.
Article in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- Challenges and strategies for managing early-to-moderate chronic kidney disease in primary care: A systematic integrative review in high-income countries.The European journal of general practice · 2026Pooled it
- Barriers and enablers to detection and management of chronic kidney disease in primary healthcare: a systematic review.BMC nephrology · 2020Pooled it
- Care Processes and Clinical Responses to Newly Detected Albuminuria: The Stockholm Creatinine Measurements (SCREAM) Project.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2026Article
- Chronic kidney disease and the alternative labels used by GPs in Australia: a qualitative interview study.BJGP open · 2025Article
- Obstacles and Opportunities for Albuminuria Testing On the Basis of the Perspective of Primary Care: A Qualitative Study.Clinical journal of the American Society of Nephrology : CJASN · 2025Article
- Article
- General practitioners' assessment and management of chronic kidney disease in older patients- a mixed methods study.BMC primary care · 2024Article
- Assessing the quality of CKD care using process quality indicators: A scoping review.PloS one · 2024Article
- Qualitative approach to better understand the trajectory of patients with early and moderate stage CKD.Clinical kidney journal · 2022Article
- Clinical code usage in UK general practice: a cohort study exploring 18 conditions over 14 years.BMJ open · 2022Article
- Article
- Trends in Quality of Care for Patients with CKD in the United States.Clinical journal of the American Society of Nephrology : CJASN · 2019Article
- Improving coding and primary care management for patients with chronic kidney disease: an observational controlled study in East London.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019Observational
- How do primary care doctors in England and Wales code and manage people with chronic kidney disease? Results from the National Chronic Kidney Disease Audit.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2018Article
Corrections and comments
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Authors and funding
5 authors at 4 institutions in 1 country.
Funding
Abstract
objectivesThis study is a process evaluation of the Quality Improvement in Chronic Kidney Disease (QICKD) study, comparing audit-based education (ABE) and sending clinical guidelines and prompts (G&P) with usual practice, in improving systolic blood pressure control in primary care. This evaluation aimed to explore how far clinical staff in participating practices were aware of the intervention, and why change in practice might have taken place.
setting4 primary care practices in England: 2 received ABE, and 2 G&P. We purposively selected 1 northern/southern/city and rural practice from each study arm (from a larger pool of 132 practices as part of the QICKD trial).
participantsThe 4 study practices were purposively sampled, and focus groups conducted with staff from each. All staff members were invited to attend.
interventionsFocus groups in each of 4 practices, at the mid-study point and at the end. 4 additional trial practices not originally selected for in-depth process evaluation took part in end of trial focus groups, to a total of 12 focus groups. These were recorded, transcribed and analysed using the framework approach.
results5 themes emerged: (1) involvement in the study made participants more positive about the CKD register; (2) clinicians did not always explain to patients that they had CKD; (3) while practitioners improved their monitoring of CKD, many were sceptical that it improved care and were more motivated by pay-for-performance measures; (4) the impact of study interventions on practice was generally positive, particularly the interaction with specialists, included in ABE; (5) the study stimulated ideas for future clinical practice.
conclusionsImproving quality in CKD is complex. Lack of awareness of clinical guidelines and scepticism about their validity are barriers to change. While pay-for-performance incentives are the main driver for change, quality improvement interventions can have a complementary influence.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.