科研之友
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摘要
Objective To determine if a community-based multifactorial intervention clinic led by a nurse practitioner would improve management of First Nations people at risk of developing chronic kidney disease. %26lt;br%26gt;Design Qualitative descriptive study. %26lt;br%26gt;Setting A nephropathy-prevention clinic in Siksika Nation, Alta. %26lt;br%26gt;Participants First Nations people with diabetes, hypertension, or dyslipidemia who were referred to the clinic. %26lt;br%26gt;Main outcome measures Changes in blood pressure (BP), hemoglobin A(1c), and low-density lipoprotein levels, as well as in use of antiplatelet therapy, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker medications, and statin therapy. %26lt;br%26gt;Results Members of the Siksika Nation were treated according to clinical practice guidelines. A total of 78 patients had at least 2 visits to the clinic and were included in this analysis (61.5% were women; mean age 56 years). Among those initially above target, a significant reduction was achieved in mean hemoglobin A(1c) (0.96%; P%26lt;.01), systolic BP (15.84 mm Hg; P%26lt;.05), diastolic BP (7.16 mm Hg; P%26lt;.001), and low-density lipoprotein (0.62 mmol/L; P%26lt;.01) levels. There was a significant increase in the proportion of patients with clinical indications who were treated with acetylsalicylic acid (42.4%; P%26lt;.01), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker medications (35.9%; P%26lt;.01), or statin therapy (35.9%; P%26lt;.01). %26lt;br%26gt;Conclusion A community-based, nurse practitioner-led clinic can improve many clinically relevant factors in patients at risk of developing chronic kidney disease. Studies have shown that achieving treatment targets is associated with a reduced risk of early death and cardiovascular events; the effect in the First Nations population on these hard clinical end points remains to be determined.
- 出版日期2013-1
