Clinical Research: Effectiveness of Integrated Care on Delaying Progression of stage 3-4 CKD in Rural Communities of Thailand (ESCORT study): A Cluster Randomized Controlled Trial

Name: Dr.Teerayuth Jiamjariyaporn

Hospital / Affiliation: Bhumirajanagarindkra Kidney Institute, Bangkok, Thailand

Home Country: Thailand

Host Country: Thailand

Year: 2012

Status of your program: COMPLETED

Title of the project: 

Effectiveness of Integrated Care on Delaying Progression of stage 3-4 CKD in Rural Communities of Thailand (ESCORT study):
A Cluster Randomized Controlled Trial

Topic: 

Chronic Kidney Disease 

Short description of the project or abstract:

In developing countries, renal specialists are scarce and physician-to-patient contact time is limited. While conventional hospital-based, physician-oriented approach has been the main focus of chronic kidney disease (CKD) care, a comprehensive multidisciplinary health care program (Integrated CKD Care) has been introduced as an alternate intervention to delay CKD progression in a community population. The main objective is to assess effectiveness of Integrated CKD Care in delaying CKD progression. We carried out a community-based, cluster randomized controlled trial. 442 stage 3-4 CKD patients were enrolled. In addition to the standard treatments provided to both groups, the patients in the intervention group also received “Integrated CKD Care”.

This was delivered by a multidisciplinary team of hospital staff in conjunction with a community CKD care network (subdistrict healthcare officers and village health volunteers) to provide group counseling during each hospital visit and quarterly home visits to monitor compliance with the treatment. Duration of the study was 2 years. The primary outcome was difference eGFR. To my knowledge, this is the first, large scale, community-based randomized controlled trial evidence demonstrating that comprehensive community-based intervention by multidisciplinary care team in conjunction with a community care network teams of non-healthcare members is feasible and can slow the rate of eGFR decline in CKD patients residing in resource-limited settings.

Learning or Research objectives:

This study aimed to compare the effectiveness on delaying CKD progression between a conventional and an integrated CKD care (ICC) provided by a multidisciplinary care team (MDCT) of hospital staffs in conjunction with the a community CKD care network (CCN, subdistrict health care officers and VHVs).