Primary Care Physicians’ Perceived Barriers to Nephrology Referral and Co-management of Patients with CKD: a Qualitative Study

Greer, Raquel C.; Liu, Yang; Cavanaugh, Kerri L.; Diamantidis, Clarissa J.; Estrella, Michelle M.; Sperati, C. John; Soman, Sandeep; Abdel-Kader, Khaled; Agrawal, Varun; Plantinga, Laura C.; Schell, Jane O.; Simon, James F.; Vassalotti, Joseph A.; Jaar, Bernard G.; Choi, Michael

doi:10.1007/s11606-019-04975-y

Cited by 58 publications

(93 citation statements)

References 35 publications

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“…Of the 20 included studies, 12 were interviews [7,10,[22][23][24][25][26][27][28][29][30][31], six were focus groups [5,6,8,[32][33][34][35][36], and two were surveys with open-ended responses [9,37] (Table 1). General practitioners, nurses, practice managers, pharmacists and medical assistants were represented across the 20 studies.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…The most commonly reported barriers related to detection and management of CKD in primary care were categorised into the 'Environmental context and resources' domain and were reported in 16 studies [5,6,8,9,22,24,[26][27][28][29][30][31][32][33][34][35][36][37]. PC-Ps frequently perceived they lacked time to devote to this task [6,8,9,22,[26][27][28][29][30][31][32][33][34][35] and this was exacerbated by the limited amount of time available for patient appointments. The complex nature of managing multiple co-morbidities also meant additional time was needed for these patients.…”

Section: Environmental Context and Resourcesmentioning

confidence: 99%

“…The complex nature of managing multiple co-morbidities also meant additional time was needed for these patients. Limited access to specialist nephrology services was also highlighted as a barrier [5,8,[34][35][36][37], and was perceived to result in delays in patients being able to make appointments. Other factors included challenges interpreting laboratory measures [8,31,32,34], for example a study conducted in the United States highlighted a barrier of laboratory results providing creatinine but not calculating eGFR [34].…”

Section: Environmental Context and Resourcesmentioning

confidence: 99%

“…Limited access to specialist nephrology services was also highlighted as a barrier [5,8,[34][35][36][37], and was perceived to result in delays in patients being able to make appointments. Other factors included challenges interpreting laboratory measures [8,31,32,34], for example a study conducted in the United States highlighted a barrier of laboratory results providing creatinine but not calculating eGFR [34]. A lack of educational resources for patients [8,33,34,37] was reported, although minimal detail was provided on the type of resources (for example brochures, online materials) that were desired.…”

Section: Environmental Context and Resourcesmentioning

confidence: 99%

“…Therefore, exploration of how best to support primary care providers (PC-P) to detect and manage CKD is needed. While several studies have explored factors impacting the management of CKD in the primary care setting [7][8][9][10], there is a need to identify common barriers and enablers in order to develop effective strategies to enhance CKD care. While a systematic review of barriers to CKD management in primary care has been published [11], this study did not explore enabling factors.…”

Section: Introductionmentioning

confidence: 99%

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Barriers and enablers to detection and management of chronic kidney disease in primary healthcare: a systematic review

2020

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Background: Chronic kidney disease (CKD) is growing population health concern worldwide, and with early identification and effective management, kidney disease progression can be slowed or prevented. Most patients with risk factors for chronic kidney disease are treated within primary healthcare. Therefore, it is important to understand how best to support primary care providers (PC-P) to detect and manage chronic kidney disease. The aim of this systematic review was to evaluate barriers and enablers to the diagnosis and management of CKD in primary care. Methods: A systematic review of qualitative research on the barriers and/or enablers to detection and/or management of CKD in adults within primary healthcare was conducted. The databases Medline (EBSCO), PubMed, Cochrane CENTRAL, CINAHL (EBSCO) and Joanna Briggs Institute Evidence Based Practice (Ovid) were searched until 27th August 2019. Barriers and/or enablers reported in each study were identified, classified into themes, and categorised according to the Theoretical Domains Framework. Results: A total of 20 studies were included in this review. The most commonly reported barriers related to detection and management of CKD in primary care were categorised into the 'Environmental context and resources' domain (n = 16 studies). Overall, the most common barrier identified was a lack of time (n = 13 studies), followed by a fear of delivering a diagnosis of CKD, and dissatisfaction with CKD guidelines (both n = 10 studies). Overall, the most common enabler identified was the presence of supportive technology to identify and manage CKD (n = 7 studies), followed by the presence of a collaborative relationship between members of the healthcare team (n = 5 studies). Conclusion: This systematic review identified a number of barriers and enablers which PC-P face when identifying and managing CKD. The findings of this review suggest a need for time-efficient strategies that promote collaboration between members of the healthcare team, and practice guidelines which consider the frequently comorbid nature of CKD. Enhanced collaboration between PC-P and nephrology services may also support PC-Ps when diagnosing CKD in primary care, and facilitate improved patient self-management.

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Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Environmental Context and Resourcesmentioning

confidence: 99%

Section: Environmental Context and Resourcesmentioning

confidence: 99%

Section: Environmental Context and Resourcesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Barriers and enablers to detection and management of chronic kidney disease in primary healthcare: a systematic review

2020

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Chronic Kidney Disease Management in Developing Countries

Badro

2023

Handbook of Medical and Health Sciences in Developing Countries

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Optimizing Multidisciplinary Care of Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus

et al. 2023

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Diabetes is the leading cause of chronic kidney disease (CKD), a condition associated with significant morbidity and mortality. As these patients have a high risk of developing cardiovascular disease and end-stage kidney disease, there is a need for early detection and early initiation of appropriate therapeutic interventions that slow disease progression and prevent adverse outcomes. Due to the complex nature of diabetes and CKD management, a holistic, patient-centered, collaborative care approach delivered by a coordinated multidisciplinary team (ideally including a clinical pharmacist as part of a comprehensive medication management program) is needed. In this review, we discuss the barriers to effective care, the current multidisciplinary approach used for CKD prevention and treatment, and the potential ways that the multidisciplinary management of CKD associated with type 2 diabetes mellitus can be refined to improve patient outcomes.

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Primary Care Physicians’ Perceived Barriers to Nephrology Referral and Co-management of Patients with CKD: a Qualitative Study

Cited by 58 publications

References 35 publications

Barriers and enablers to detection and management of chronic kidney disease in primary healthcare: a systematic review

Barriers and enablers to detection and management of chronic kidney disease in primary healthcare: a systematic review

Chronic Kidney Disease Management in Developing Countries

Optimizing Multidisciplinary Care of Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus

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