@entity740 ( @entity740 ) stages 3 to 5, affects 6-7% of the adult population and is an important risk factor for both @entity8 and @entity65 . This paper describes a quality improvement project that aimed to establish consistent implementation of best practice in @entity1 with stage 3-5 @entity8 who were managed in primary care. The intervention was a Care Bundle for @entity740 . The bundle included three evidence-based, high impact interventions based on National Institute for Care Excellence (NICE, 2008) guidance, with an additional and novel self-management element. 29 GP Practices in England and Wales began the study. They undertook training in clinical management of @entity740 and in facilitation of self-management, with the self-management content designed and led by @entity1 . Practices were asked to report baseline and then monthly outcome data extracted from practice computer systems. The project team provided implementation and ongoing quality improvement support for participating Practices. Ten Practices dropped out of the study following the training. Data submissions were incomplete in six Practices who continued to apply the care bundle. At the project end, a decision was taken by the study team to perform the final analysis on those thirteen Practices which completed the project and submitted at least six sets of monthly Practice-level outcome data. In these Practices the Care Bundle was applied to under 20% of the registered @entity740 stage 3 to 5 population in 5 Practices, 20-29% in 3 Practices, 30-49% in 2 Practices and >= 50% in 3 Practices (998 @entity1 in total). Of these, 671 @entity1 (75%) agreed to the self-management component of the intervention. The reliability (at project end) in those who received the Bundle was 100%. The Bundle was applied to an additional 315 @entity1 in the six Practices who completed the project but did not submit regular practice-level monthly data. In the thirteen remaining Practices, the achievement of NICE (2008) blood pressure targets at the start of the project was 74.8% in @entity1 with @entity740 stage 3-5 and no @entity6 and 48% in @entity1 with @entity740 stage 3-5 and @entity6 . At the project end these figures in the same Practices were 76.7% and 49.2% respectively. These improvements were achieved in spite of Practices increasing their recording of prevalence rate (that is, identifying and recording more @entity1 with @entity740 on the Practice @entity740 Register). In conclusion, a care bundle can be implemented in primary care. However, maintaining engagement with primary care health care professionals and maximising exposure to an intervention in @entity1 seen infrequently are significant challenges to generalisation and sustainability.

A quality improvement project to improve the effectiveness and @entity1 -centredness of management of @entity1 with mild-to-moderate XXXX in primary care.

@entity1 :: ('9606', 'Species') :: ['patients', 'people'] @entity8 :: ('MESH:D007674', 'Disease') :: ['advanced kidney disease', 'kidney disease'] @entity6 :: ('MESH:D003920', 'Disease') :: ['diabetes'] @entity740 :: ('MESH:D051436', 'Disease') :: ['Chronic kidney disease', 'CKD'] @entity65 :: ('MESH:D002318', 'Disease') :: ['cardiovascular disease']
@entity8 :: (MESH:D007674,Disease) :: ['kidney disease']
