Thursday, 6 March 2008

Integrated vascular control programmes

We have heard much talk that CKD spells cardiac, kidney and diabetes over the last few years. Speaking with practice nurses, integration is now becoming a reality for some patients. The publication of “The Handbook for Vascular Risk Assessment , Risk Reduction and Risk Management” or “the blue book” as we have come to know it over its long gestation, by the National Screening Committee should help drive co-ordinated vascular care. It draws together the evidence base and best practice models that can be adopted or adapted for local use in practices or across primary care organisations.

Melanie Davies (Professor of Diabetes Medicine at the University of Leicester) and her team have done a sterling job of sifting and compiling the literature. CKD is flagged as a vascular risk marker and the benefits of early detection followed by risk assessment and management are highlighted. If there is a feeling that kidney disease doesn’t get the same sort of look in as diabetes then that frankly reflects the amount and level of evidence in diabetes care compared to early CKD. If we, the system – because that is what the NHS, us; achieve the level of integrated care and quality of risk management that has already been achieved by individual earlier doctors of the approaches cited in the blue book a lot of people with stages I-3 CKD will benefit. I have also added it to the bedtime reading list of the blog but at 150 pages it’s really a document for the team to dip in and out of and from which local services can pick and mix the tools they wish to employ to manage vascular risk for individuals in their populations.