249 component intervention, Grip on Your Kidneys (GoYK). This intervention focused at the needs of patients with mild to severe CKD and professionals in general practices and nephrology clinics. Patients and professionals helped to select intervention strategies to ensure these fitted the competences of patients with LHL and the context of CKD. The final intervention consisted of a website, consultation card and brochures to increase patients’ CKD knowledge and their competences to prepare, act upon, and maintain self-management. In addition, we developed an e-learning and a workshop to train health care professionals to identify and support patients with LHL better. Evaluation showed the different components of the intervention were usable, useful and comprehensible for CKD patients with LHL and health care professionals. In Chapter 5, we show the results of a quasi-experimental study with an intervention and a control group, including 147 patients with mild to severe CKD and 48 professionals from four general practices and five nephrology clinics. Data was collected at three time points, at baseline and after 4 and 9 months, using questionnaires but also from the Electronic Patient Records. We found GoYK to be effective in reducing hypertension and in improving the quality of consultations. Patients in the intervention group could, after 4 months, better share their needs and emotions with professionals, and health behaviors were discussed more during consultations. Moreover, professionals in the intervention group reported improved use of health literacy strategies to provide information, and enable shared-decision making and self-management. We found no significant effect on self-management, but self-management tended to improve in patients who showed unhealthy behaviors at baseline. A process evaluation revealed that patients and professionals used GoYK well and found the intervention to be useful. Patients from general practices used the intervention relatively less and were less satisfied than patients from nephrology clinics. In Chapter 6, we use a Markov model to evaluate the effects of GoYK on qualityadjusted life years (QALYs) and healthcare costs in the Netherlands, compared to care as usual. We show that, if implemented in the Dutch healthcare system, the intervention would not only be cost-effective but also cost saving. Derived from the effect of GoYK on hypertension, associated with CKD onset and progression, the intervention would yield a cost-saving of €28,616, and a gain of 0.37 Quality Adjusted Life Years (QALYs) per CKD patient across the life course. The effects of
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