GPs’ views on managing advanced chronic kidney disease in primary care: a qualitative study

Tonkin‐Crine, Sarah; Santer, Miriam; Leydon, Geraldine; Murtagh, Fliss E.M.; Farrington, Ken; Caskey, Fergus; Rayner, Hugh; Roderick, Paul

doi:10.3399/bjgp15x685693

Cited by 30 publications

(49 citation statements)

References 22 publications

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“…For patients with more severe kidney disease requiring RRT (dialysis and transplant), the main location of care is usually secondary care. This more severe population is not, therefore, the main focus of this review, although primary care still plays an important supportive role and there is evidence that more guidance is needed for GPs in this area 42. There is also mixed evidence about screening for CKD in general populations, which is not discussed in detail, although there is some evidence to support focused screening, for example, in people with diabetes or hypertension, as is currently undertaken as part of the UK National Health Service (NHS) Health Check programme 43–45…”

Section: Introductionmentioning

confidence: 99%

Chronic kidney disease: identification and management in primary care

Fraser¹,

Blakeman²

2016

POR

126

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Chronic kidney disease (CKD) is an important and common noncommunicable condition globally. In national and international guidelines, CKD is defined and staged according to measures of kidney function that allow for a degree of risk stratification using commonly available markers. It is often asymptomatic in its early stages, and early detection is important to reduce future risk. The risk of cardiovascular outcomes is greater than the risk of progression to end-stage kidney disease for most people with CKD. CKD also predisposes to acute kidney injury – a major cause of morbidity and mortality worldwide. Although only a small proportion of people with CKD progress to end-stage kidney disease, renal replacement therapy (dialysis or transplantation) represents major costs for health care systems and burden for patients. Efforts in primary care to reduce the risks of cardiovascular disease, acute kidney injury, and progression are therefore required. Monitoring renal function is an important task, and primary care clinicians are well placed to oversee this aspect of care along with the management of modifiable risk factors, particularly blood pressure and proteinuria. Good primary care judgment is also essential in making decisions about referral for specialist nephrology opinion. As CKD commonly occurs alongside other conditions, consideration of comorbidities and patient wishes is important, and primary care clinicians have a key role in coordinating care while adopting a holistic, patient-centered approach and providing continuity. This review aims to summarize the vital role that primary care plays in predialysis CKD care and to outline the main considerations in its identification, monitoring, and clinical management in this context.

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Section: Introductionmentioning

confidence: 99%

Chronic kidney disease: identification and management in primary care

Fraser¹,

Blakeman²

2016

POR

126

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show abstract

“…As such, they had to weigh the personal aspects against their professional responsibility and expertise concerning the disease. One challenge for the HCPs, as shown in Tonkin-Crine et al [36], was the discrepancy between the patient's subjective experiences on the one hand and clinical measures of the disease on the other. For example, it was a challenge to advocate diet adjustments to patients with kidney failure who had not yet experienced symptoms [36].…”

Section: Individualizing the Professional Approach Within The Clinicamentioning

confidence: 99%

“…One challenge for the HCPs, as shown in Tonkin-Crine et al [36], was the discrepancy between the patient's subjective experiences on the one hand and clinical measures of the disease on the other. For example, it was a challenge to advocate diet adjustments to patients with kidney failure who had not yet experienced symptoms [36]. It was also challenging for HCPs when patients resisted modifying their lifestyle to optimize the treatment effects [21,34], for example making decisions that might worsen symptoms and speed its progression.…”

Section: Individualizing the Professional Approach Within The Clinicamentioning

confidence: 99%

Working with patients suffering from chronic diseases can be a balancing act for health care professionals - a meta-synthesis of qualitative studies

Holmen

Larsen

Sallinen

et al. 2020

BMC Health Serv Res

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Background: The number of patients with long-term chronic diseases is increasing. These patients place a strain on health care systems and health care professionals (HCPs). Presently, we aimed to systematically review the literature on HCPs' experiences working with patients with long-term chronic diseases such as type 2 diabetes, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD). Method: A systematic search of papers published between 2002 and July 2019 was conducted in the Embase, AMED, PsycINFO, MEDLINE, CINAHL, and COCHRANE databases to identify studies reporting qualitative interviews addressing HCPs' experiences working with adults with COPD, CKD or type 2 diabetes. An interdisciplinary research group were involved in all phases of the study. With the help of NVivo, extracts of each paper were coded, and codes were compared across papers and refined using translational analysis. Further codes were clustered in categories that in turn formed overarching themes. Results: Our comprehensive search identified 4170 citations. Of these, 20 papers met our inclusion criteria. Regarding HCPs' experiences working with patients with COPD, CKD, or type 2 diabetes, we developed 10 subcategories that formed three overarching main themes of work experiences: 1) individualizing one's professional approach within the clinical encounter; 2) managing one's emotions over time; 3) working to maintain professionalism. Overall these three themes suggest that HCPs' work is a complex balancing act depending on the interaction between patient and professional, reality and professional ideals, and contextual support and managing one's own emotions.

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“…Unfortunately, Jordan has no relevant database or registry through which CKD can be detected at its early stages and be appropriately managed. Studies showed that Jordanians at risk for CKD are unaware of importance of early detection of CKD (Khalil & Abdalrahim ; Khalil et al ) and primary physicians lack knowledge and skills to screen and manage CKD (Tonkin‐Crine et al ).…”

Section: Introductionmentioning

confidence: 99%