Awareness and Discussions About Chronic Kidney Disease Among African-Americans with Chronic Kidney Disease and Hypertension: a Mixed Methods Study

Karly A. Murphy, Raquel C. Greer, Debra L. Roter, Deidra C. Crews, Patti L. Ephraim, Kathryn A. Carson, Lisa A. Cooper, Michael C. Albert, L. Ebony Boulware

Research output: Contribution to journalArticle

Abstract

Background: Routine primary care visits provide an educational opportunity for African-Americans with chronic kidney disease (CKD) and CKD risk factors such as hypertension. The nature of patient-physician discussions about CKD and their impact on CKD awareness in this population have not been well explored. Objective: To characterize patient CKD awareness and discussions about CKD between patients and primary care physicians (PCPs). Design: Mixed methods study. Patients: African-American patients with uncontrolled hypertension (≥ 140/90 mmHg) and CKD (albuminuria or eGFR < 60 ml/min/1.73 m2) recruited from an urban primary care clinic. Main Measures: We assessed patient CKD awareness with questionnaires and audio-recorded patients-PCP discussions during a routine visit. We characterized discussions and used multivariate regression analysis to identify independent patient and visit predictors of CKD awareness or CKD discussions. Results: Among 48 African-American patients with uncontrolled hypertension and CKD, 29% were aware of their CKD. After adjustment, CKD awareness was associated with moderate-severe CKD (stages 3–4) (vs. mild CKD [stages 1–2]) (prevalence ratio [PR] 2.82; 95% CI 1.18–6.78) and inversely associated with diabetes (vs. without diabetes) (PR 0.28; 95% CI 0.10–0.75). CKD discussions occurred in 30 (63%) visits; most focused on laboratory assessment (n = 23, 77%) or risk factor management to delay CKD progression (n = 19, 63%). CKD discussions were associated with moderate-severe CKD (vs. mild CKD) (PR 1.57; 95% CI 1.04–2.36) and diabetes (vs. without diabetes) (PR 1.42; 95% CI 1.09–1.85), and inversely associated with uncontrolled hypertension (vs. controlled) (PR 0.58; 95% CI 0.92–0.89). In subgroup analysis, follow-up CKD awareness did not change by presence or absence of CKD discussion (10.5% vs. 7.7%, p = 0.8). Conclusions: In patients at risk of CKD progression, few were aware of CKD, and CKD discussions were not associated with CKD awareness. More resources may be needed to enhance the clarity of clinical messages regarding CKD and its significance for patients’ health. Trial Registration: ClinicalTrials.gov Identifier: NCT01902719

Original languageEnglish (US)
JournalJournal of general internal medicine
DOIs
StateAccepted/In press - Jan 1 2019

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Chronic Renal Insufficiency
African Americans
Hypertension
Primary Care Physicians
Disease Progression
Primary Health Care
Patient Care

Keywords

  • awareness
  • chronic disease
  • chronic kidney disease
  • hypertension
  • primary care

ASJC Scopus subject areas

  • Internal Medicine

Cite this

@article{a73c92ead9b74689871a5e90f9b58437,
title = "Awareness and Discussions About Chronic Kidney Disease Among African-Americans with Chronic Kidney Disease and Hypertension: a Mixed Methods Study",
abstract = "Background: Routine primary care visits provide an educational opportunity for African-Americans with chronic kidney disease (CKD) and CKD risk factors such as hypertension. The nature of patient-physician discussions about CKD and their impact on CKD awareness in this population have not been well explored. Objective: To characterize patient CKD awareness and discussions about CKD between patients and primary care physicians (PCPs). Design: Mixed methods study. Patients: African-American patients with uncontrolled hypertension (≥ 140/90 mmHg) and CKD (albuminuria or eGFR < 60 ml/min/1.73 m2) recruited from an urban primary care clinic. Main Measures: We assessed patient CKD awareness with questionnaires and audio-recorded patients-PCP discussions during a routine visit. We characterized discussions and used multivariate regression analysis to identify independent patient and visit predictors of CKD awareness or CKD discussions. Results: Among 48 African-American patients with uncontrolled hypertension and CKD, 29{\%} were aware of their CKD. After adjustment, CKD awareness was associated with moderate-severe CKD (stages 3–4) (vs. mild CKD [stages 1–2]) (prevalence ratio [PR] 2.82; 95{\%} CI 1.18–6.78) and inversely associated with diabetes (vs. without diabetes) (PR 0.28; 95{\%} CI 0.10–0.75). CKD discussions occurred in 30 (63{\%}) visits; most focused on laboratory assessment (n = 23, 77{\%}) or risk factor management to delay CKD progression (n = 19, 63{\%}). CKD discussions were associated with moderate-severe CKD (vs. mild CKD) (PR 1.57; 95{\%} CI 1.04–2.36) and diabetes (vs. without diabetes) (PR 1.42; 95{\%} CI 1.09–1.85), and inversely associated with uncontrolled hypertension (vs. controlled) (PR 0.58; 95{\%} CI 0.92–0.89). In subgroup analysis, follow-up CKD awareness did not change by presence or absence of CKD discussion (10.5{\%} vs. 7.7{\%}, p = 0.8). Conclusions: In patients at risk of CKD progression, few were aware of CKD, and CKD discussions were not associated with CKD awareness. More resources may be needed to enhance the clarity of clinical messages regarding CKD and its significance for patients’ health. Trial Registration: ClinicalTrials.gov Identifier: NCT01902719",
keywords = "awareness, chronic disease, chronic kidney disease, hypertension, primary care",
author = "Murphy, {Karly A.} and Greer, {Raquel C.} and Roter, {Debra L.} and Crews, {Deidra C.} and Ephraim, {Patti L.} and Carson, {Kathryn A.} and Cooper, {Lisa A.} and Albert, {Michael C.} and Boulware, {L. Ebony}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s11606-019-05540-3",
language = "English (US)",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",

}

TY - JOUR

T1 - Awareness and Discussions About Chronic Kidney Disease Among African-Americans with Chronic Kidney Disease and Hypertension

T2 - a Mixed Methods Study

AU - Murphy, Karly A.

AU - Greer, Raquel C.

AU - Roter, Debra L.

AU - Crews, Deidra C.

AU - Ephraim, Patti L.

AU - Carson, Kathryn A.

AU - Cooper, Lisa A.

AU - Albert, Michael C.

AU - Boulware, L. Ebony

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Routine primary care visits provide an educational opportunity for African-Americans with chronic kidney disease (CKD) and CKD risk factors such as hypertension. The nature of patient-physician discussions about CKD and their impact on CKD awareness in this population have not been well explored. Objective: To characterize patient CKD awareness and discussions about CKD between patients and primary care physicians (PCPs). Design: Mixed methods study. Patients: African-American patients with uncontrolled hypertension (≥ 140/90 mmHg) and CKD (albuminuria or eGFR < 60 ml/min/1.73 m2) recruited from an urban primary care clinic. Main Measures: We assessed patient CKD awareness with questionnaires and audio-recorded patients-PCP discussions during a routine visit. We characterized discussions and used multivariate regression analysis to identify independent patient and visit predictors of CKD awareness or CKD discussions. Results: Among 48 African-American patients with uncontrolled hypertension and CKD, 29% were aware of their CKD. After adjustment, CKD awareness was associated with moderate-severe CKD (stages 3–4) (vs. mild CKD [stages 1–2]) (prevalence ratio [PR] 2.82; 95% CI 1.18–6.78) and inversely associated with diabetes (vs. without diabetes) (PR 0.28; 95% CI 0.10–0.75). CKD discussions occurred in 30 (63%) visits; most focused on laboratory assessment (n = 23, 77%) or risk factor management to delay CKD progression (n = 19, 63%). CKD discussions were associated with moderate-severe CKD (vs. mild CKD) (PR 1.57; 95% CI 1.04–2.36) and diabetes (vs. without diabetes) (PR 1.42; 95% CI 1.09–1.85), and inversely associated with uncontrolled hypertension (vs. controlled) (PR 0.58; 95% CI 0.92–0.89). In subgroup analysis, follow-up CKD awareness did not change by presence or absence of CKD discussion (10.5% vs. 7.7%, p = 0.8). Conclusions: In patients at risk of CKD progression, few were aware of CKD, and CKD discussions were not associated with CKD awareness. More resources may be needed to enhance the clarity of clinical messages regarding CKD and its significance for patients’ health. Trial Registration: ClinicalTrials.gov Identifier: NCT01902719

AB - Background: Routine primary care visits provide an educational opportunity for African-Americans with chronic kidney disease (CKD) and CKD risk factors such as hypertension. The nature of patient-physician discussions about CKD and their impact on CKD awareness in this population have not been well explored. Objective: To characterize patient CKD awareness and discussions about CKD between patients and primary care physicians (PCPs). Design: Mixed methods study. Patients: African-American patients with uncontrolled hypertension (≥ 140/90 mmHg) and CKD (albuminuria or eGFR < 60 ml/min/1.73 m2) recruited from an urban primary care clinic. Main Measures: We assessed patient CKD awareness with questionnaires and audio-recorded patients-PCP discussions during a routine visit. We characterized discussions and used multivariate regression analysis to identify independent patient and visit predictors of CKD awareness or CKD discussions. Results: Among 48 African-American patients with uncontrolled hypertension and CKD, 29% were aware of their CKD. After adjustment, CKD awareness was associated with moderate-severe CKD (stages 3–4) (vs. mild CKD [stages 1–2]) (prevalence ratio [PR] 2.82; 95% CI 1.18–6.78) and inversely associated with diabetes (vs. without diabetes) (PR 0.28; 95% CI 0.10–0.75). CKD discussions occurred in 30 (63%) visits; most focused on laboratory assessment (n = 23, 77%) or risk factor management to delay CKD progression (n = 19, 63%). CKD discussions were associated with moderate-severe CKD (vs. mild CKD) (PR 1.57; 95% CI 1.04–2.36) and diabetes (vs. without diabetes) (PR 1.42; 95% CI 1.09–1.85), and inversely associated with uncontrolled hypertension (vs. controlled) (PR 0.58; 95% CI 0.92–0.89). In subgroup analysis, follow-up CKD awareness did not change by presence or absence of CKD discussion (10.5% vs. 7.7%, p = 0.8). Conclusions: In patients at risk of CKD progression, few were aware of CKD, and CKD discussions were not associated with CKD awareness. More resources may be needed to enhance the clarity of clinical messages regarding CKD and its significance for patients’ health. Trial Registration: ClinicalTrials.gov Identifier: NCT01902719

KW - awareness

KW - chronic disease

KW - chronic kidney disease

KW - hypertension

KW - primary care

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U2 - 10.1007/s11606-019-05540-3

DO - 10.1007/s11606-019-05540-3

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JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

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