508R - Research Paper

Abstract
Aim:
To determine whether the integration of an electronic clinical decision support tool (eCDSS) within electronic medical records could increase diagnosis and management of CKD in Australian PCPs. 

Method:
A systematic literature review was conducted across three databases targeted toward studies that involved eCDSS use in PCPs with specific focus on diagnosis, documentation and management of CKD.

Results:
A total of 17 studies met inclusion criteria. Of these, 8 identified CKD diagnostic coding as primary or secondary outcome. 4 demonstrated statistically significant increase in coding following integration of eCDSS tool. Improvement in measurement of urinary albumin-creatinine ratio was demonstrated in 3 of 4 studies but improvement in guideline recommended management was only demonstrated in 3 of 16 studies. 

Conclusion:
This review was inconclusive and further studies are required to investigate whether eCDSS tools can prompt improved identification and guideline recommenced management of CKD in PCPs

430Q - Research Paper

Abstract
Aim:
The aim of our audit was to distinguish subclasses of HTN that were identified by the ABPM results.

Method:
Retrospective audit: inclusion of patients with CKD stages 4-5, home-dialysis, or transplant with OBP >140/90 and patients who had symptoms of low BP on multiple antihypertensives.  Data was collected from ABPM reports.

Results:
A total of 28 ABPM reports were reviewed.  Mean age of patients was 63.  Female 35.7%.  Patients with diabetes 21.4%, and Maori and Pacifica 21.4%.  White coat HTN 35.7%, uncontrolled day time BP 78.5%, uncontrolled night-time BP 85.7%, nocturnal dipper 35.8%, non-dipper 46.4%, reverse dippers 17.8%.  Interestingly there were 0% cases of masked HTN.

Conclusion:
ABPM is a useful tool to detect sub-classes of HTN, this helps to optimise HTN treatments.  Referral criteria is modified to identify patients with masked HTN.  Data showed patients with diabetes, Maori & Pacifica background were underrepresented.  We are considering rural HTN clinics to address the issue of inequity in service delivery.

444Q - Research Paper

Abstract
Aim:
The purpose of the AKCIS project is to develop a digitally integrated kidney care data source that is secure, standardised and represents meaningful information to assist users in facilitating health care improvement. 

Method:
Commissioned by the Queensland State-wide Renal Clinical Network, an external review of renal services was undertaken which resulted in the establishment of AKCIS in 2020. The kidney care community has continued to influence the selection of included information and how insights are presented. 

Results:
AKCIS provides reports on kidney transplantation, acute kidney injuries, dialysis provision (chronic centre-based, home and independent haemodialysis (HD) and peritoneal dialysis (PD)), distance and time travel and (early 2024) advance care planning. Reporting can be filtered by age, gender, Aboriginal and Torres Strait Islander status and other data. Reports assist understanding of the provision of kidney health care services specific to Hospital and Healthcare Services. 

Conclusion:
AKCIS receives recurrent funding for the ongoing maintenance, expansion of reporting, and ongoing utility assessments of the platform in meeting Queensland’s renal community and State needs, and currently has exciting new reports in train.

600 - Research Paper

Abstract
Aim
The database will:

Methods:
Successful establishment of the database required but was not limited to:
• a clinical governance framework
• an evaluation of existing excel spreadsheets to identify the data collection criteria
• a Software-Purchase-and-Installation-Request (SPIR), and
• Memorandum of Understanding (MoU). 

Results:
MHHS anticipates the development of a REDCap database will support accessible data capture and reporting for the entire service in the provision of best patient care.

Conclusion:
The MHHS Renal Service is keen to share the learnings and pragmatics of its database to support considerations of other Renal Service providers and potentially optimise similar data collection mechanisms. 

233R - Research Paper

Abstract
Aim:
To explore the experiences and perceptions of members of the MDT managing people with kidney disease regarding virtual meetings, in the setting of a single adult acute dialysis unit affiliated to a large metropolitan teaching hospital.

Method:
Semi-structured interviews were conducted amongst MDT members to explore their experiences and perspectives of virtual MDT meetings. Maximal variation sampling was used to ensure adequate representation by gender and professional roles. All interviews were audiotaped and transcribed verbatim, before being analysed by two researchers independently using the Theoretical Domains Framework (TDF). Disagreements were resolved by a third researcher.

Results:
Of the nine participants interviewed, six were females and the majority were nurses. Three main themes emerged within the three primary TDF domains: impact on staff and patient outcomes; limited technological skills, and opportunities for improvement. From the four intermediate TDF domains, another four themes were captured: professional responsibility; impact on engagement; barriers to participation; and desire to provide optimal patient care.

Conclusion:
Healthcare professionals reported that virtual MDT meetings overcame geographic barriers and infection control restrictions and they offered possibilities for broader inclusivity. However, strategies are needed to overcome technological issues, improve participants’ skills to navigate technology, and optimise active participation.