Effectiveness of Integrated Care on Delaying Chronic Kidney Disease Progression in Rural Communities of Thailand
Condition: Chronic Kidney Disease
MeSH terms: Kidney Diseases; Renal Insufficiency, Chronic; Disease Progression
Study type: Interventional

Summary: 
      If primary health-care officers and Villages Health Volunteers (VHVs) be trained to render
      proper CKD care, it is interesting if their intimate relationship and commitment to their
      responsible village households will result in better outcomes when compared with the
      conventional care model as mention above. In this project, we plan to compare the
      effectiveness of a conventional care program against an integrated multidisciplinary CKD care
      program provided by nephrologists in conjunction with well-trained paramedical personnel and
      VHVs on CKD progression.
    

Detailed description: 
      Background The unique characteristic of community-health care in Thailand is a system of
      primary- health care officers and Village Health Volunteers (VHVs) providing basic health
      care to more than 90% of Thai population. Should these allied personnel be trained on how to
      render proper chronic kidney disease (CKD) care, it would be interesting to study whether
      their role play care will result in better quality of CKD care.

      Design This study is a community-based cluster randomized controlled trial to be conducted in
      2 districts of Kamphaeng Phet Province, located about 400 kilometers north of Bangkok. About
      300 stage 3-4 CKD patients will be enrolled to each of the 2 treatment groups. Patients in
      both groups will be treated according to The National Kidney Foundation Kidney Disease
      Outcomes Quality Initiative guidelines. The District 1 (control group) patients will be
      provided a conventional CKD care. For the District 2 (intervention group) patients, an
      integrated CKD care program will be provided by the multidisciplinary team of district
      hospital in conjunction with the community CKD care networks (i.e. primary-health care
      officers and VHVs). The key activities of integrated CKD care program are live demonstration
      about treatment and optimal diets for CKD patients which will be provided during each
      hospital visit and quarterly home visits. Clinical and laboratory parameters of all cases
      will be assessed every 3 months. Duration of the study is 24 months. The primary outcome of
      this study is the rate of eGFR decline. The secondary outcomes are time of initiation of
      dialysis, cardiovascular mortality, and all-cause mortality.
    

Intervention name(s): Integrated Chronic Kidney Disease care; Conventional CKD care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Activities of integrated CKD care program, which will be provided during each hospital visit and quarterly home visits, are live demonstration about treatment and optimal diets for CKD patients, monitor drug compliance.; group counselling about optimal diets for CKD patients
Other intervention name(s): Multidisciplinary team + Community CKD care network; group counselling
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Chronic Kidney Disease; Integrated Chronic Kidney Disease Care; Village Health Volunteers