Effectiveness of integrated care on delaying chronic kidney disease progression in rural communities of Thailand (ESCORT study): rationale and design of the study [NCT01978951]

Teerayuth Jiamjariyaporn, Atiporn Ingsathit, Kriang Tungsanga, Chatri Banchuin, Kotcharat Vipattawat, Suphattra Kanchanakorn, Vinai Leesmidt, Watcharapong Watcharasaksilp, Akhathai Saetie, Chanida Pachotikarn, Sunard Taechangam, Tanyarat Teerapornlertratt, Teerachai Chantarojsiri, Visith Sitprija, Teerayuth Jiamjariyaporn, Atiporn Ingsathit, Kriang Tungsanga, Chatri Banchuin, Kotcharat Vipattawat, Suphattra Kanchanakorn, Vinai Leesmidt, Watcharapong Watcharasaksilp, Akhathai Saetie, Chanida Pachotikarn, Sunard Taechangam, Tanyarat Teerapornlertratt, Teerachai Chantarojsiri, Visith Sitprija

Abstract

Background: In developing countries, accessibility to specialists, and physician to patient contact time is limited. In Thailand, A unique community health service is provided by subdistrict health care officers and Village Health Volunteers (VHVs). If the personnel were trained on proper chronic kidney disease (CKD) care, CKD progression would be delayed.

Methods/design: We conducted a community-based, cluster randomized controlled trial at Kamphaeng Phet Province, located about 400 kilometers north of Bangkok. Two out of eleven districts of the province were randomly selected. Approximatly 500 stage 3-4 CKD patients from 2 districts were enrolled. Patients in both groups will be treated with standard guidelines. The patients in intervention group were provided the additional treatments by multidisciplinary team in conjunction with community CKD care network (subdistrict health care officers and VHVs) which will provide group counseling during each hospital visit and quarterly home visits to monitor dietary protein and sodium intake, blood pressure measurement and drug compliance. Duration of the study is 2 years. The primary outcome is the difference of rate of eGFR decline. The secondary outcomes are laboratory parameters and incidence of clinical endpoints such as mortality rate and cardiovascular events, end-stage renal disease (ESRD), etc.

Discussion: Insights of this study may set forth a new standard of community-based CKD care.

Trial registration: NCT01978951.

Figures

Figure 1
Figure 1
Map of Thailand.
Figure 2
Figure 2
Map of Kamphaeng Phet Province. The numbers represent respective districts of the Province. District No.5 and No.8 denote Khlong Khlung District (Intervention group) and Sai Thong Wattana District (Control group), respectively.
Figure 3
Figure 3
Design of the study.

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