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

On behalf of the National Kidney Foundation Education Committee

Research output: Contribution to journalArticle

Abstract

Background: Effective co-management of patients with chronic kidney disease (CKD) between primary care physicians (PCPs) and nephrologists is increasingly recognized as a key strategy to ensure the delivery of efficient and high-quality CKD care. However, the co-management of patients with CKD remains suboptimal. Objective: We aimed to identify PCPs’ perceptions of key barriers and facilitators to effective co-management of patients with CKD at the PCP-nephrology interface. Study Design: Qualitative study Setting and Participants: Community-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC; and San Francisco, CA Approach: We conducted four focus groups of PCPs. Two members of the research team coded transcribed audio-recorded interviews and identified major themes. Key Results: Most of the 32 PCPs (59% internists and 41% family physicians) had been in practice for > 10 years (97%), spent ≥ 80% of their time in clinical care (94%), and practiced in private (69%) or multispecialty group practice (16%) settings. PCPs most commonly identified barriers to effective co-management of patients with CKD focused on difficulty developing working partnerships with nephrologists, including (1) lack of timely adequate information exchange (e.g., consult note not received or CKD care plan unclear); (2) unclear roles and responsibilities between PCPs and nephrologists; and (3) limited access to nephrologists (e.g., unable to obtain timely consultations or easily contact nephrologists with concerns). PCPs expressed a desire for “better communication tools” (e.g., shared electronic medical record) and clear CKD care plans to facilitate improved PCP-nephrology collaboration. Conclusions: Interventions facilitating timely adequate information exchange, clear delineation of roles and responsibilities between PCPs and nephrologists, and greater access to specialist advice may improve the co-management of patients with CKD.

Original languageEnglish (US)
JournalJournal of general internal medicine
DOIs
StatePublished - Jan 1 2019

Fingerprint

Nephrology
Primary Care Physicians
Chronic Renal Insufficiency
Referral and Consultation
Baltimore
Group Practice
San Francisco
Electronic Health Records
Family Physicians
Focus Groups
Nephrologists
Communication
Interviews

Keywords

  • chronic kidney disease
  • co-management
  • nephrology
  • primary care
  • qualitative research

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Primary Care Physicians’ Perceived Barriers to Nephrology Referral and Co-management of Patients with CKD : a Qualitative Study. / On behalf of the National Kidney Foundation Education Committee.

In: Journal of general internal medicine, 01.01.2019.

Research output: Contribution to journalArticle

@article{74b5781beab94b6086b90c76b7b5e0cd,
title = "Primary Care Physicians’ Perceived Barriers to Nephrology Referral and Co-management of Patients with CKD: a Qualitative Study",
abstract = "Background: Effective co-management of patients with chronic kidney disease (CKD) between primary care physicians (PCPs) and nephrologists is increasingly recognized as a key strategy to ensure the delivery of efficient and high-quality CKD care. However, the co-management of patients with CKD remains suboptimal. Objective: We aimed to identify PCPs’ perceptions of key barriers and facilitators to effective co-management of patients with CKD at the PCP-nephrology interface. Study Design: Qualitative study Setting and Participants: Community-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC; and San Francisco, CA Approach: We conducted four focus groups of PCPs. Two members of the research team coded transcribed audio-recorded interviews and identified major themes. Key Results: Most of the 32 PCPs (59{\%} internists and 41{\%} family physicians) had been in practice for > 10 years (97{\%}), spent ≥ 80{\%} of their time in clinical care (94{\%}), and practiced in private (69{\%}) or multispecialty group practice (16{\%}) settings. PCPs most commonly identified barriers to effective co-management of patients with CKD focused on difficulty developing working partnerships with nephrologists, including (1) lack of timely adequate information exchange (e.g., consult note not received or CKD care plan unclear); (2) unclear roles and responsibilities between PCPs and nephrologists; and (3) limited access to nephrologists (e.g., unable to obtain timely consultations or easily contact nephrologists with concerns). PCPs expressed a desire for “better communication tools” (e.g., shared electronic medical record) and clear CKD care plans to facilitate improved PCP-nephrology collaboration. Conclusions: Interventions facilitating timely adequate information exchange, clear delineation of roles and responsibilities between PCPs and nephrologists, and greater access to specialist advice may improve the co-management of patients with CKD.",
keywords = "chronic kidney disease, co-management, nephrology, primary care, qualitative research",
author = "{On behalf of the National Kidney Foundation Education Committee} and Greer, {Raquel Charles} and Yang Liu and Kerri Cavanaugh and Clarissa Diamantidis and Estrella, {Michelle M.} and Sperati, {C John} and Sandeep Soman and Khaled Abdel-Kader and Varun Agrawal and Plantinga, {Laura C.} and Schell, {Jane O.} and Simon, {James F.} and Vassalotti, {Joseph A.} and Bernard Jaar and Choi, {Michael J.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s11606-019-04975-y",
language = "English (US)",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",

}

TY - JOUR

T1 - Primary Care Physicians’ Perceived Barriers to Nephrology Referral and Co-management of Patients with CKD

T2 - a Qualitative Study

AU - On behalf of the National Kidney Foundation Education Committee

AU - Greer, Raquel Charles

AU - Liu, Yang

AU - Cavanaugh, Kerri

AU - Diamantidis, Clarissa

AU - Estrella, Michelle M.

AU - Sperati, C John

AU - Soman, Sandeep

AU - Abdel-Kader, Khaled

AU - Agrawal, Varun

AU - Plantinga, Laura C.

AU - Schell, Jane O.

AU - Simon, James F.

AU - Vassalotti, Joseph A.

AU - Jaar, Bernard

AU - Choi, Michael J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Effective co-management of patients with chronic kidney disease (CKD) between primary care physicians (PCPs) and nephrologists is increasingly recognized as a key strategy to ensure the delivery of efficient and high-quality CKD care. However, the co-management of patients with CKD remains suboptimal. Objective: We aimed to identify PCPs’ perceptions of key barriers and facilitators to effective co-management of patients with CKD at the PCP-nephrology interface. Study Design: Qualitative study Setting and Participants: Community-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC; and San Francisco, CA Approach: We conducted four focus groups of PCPs. Two members of the research team coded transcribed audio-recorded interviews and identified major themes. Key Results: Most of the 32 PCPs (59% internists and 41% family physicians) had been in practice for > 10 years (97%), spent ≥ 80% of their time in clinical care (94%), and practiced in private (69%) or multispecialty group practice (16%) settings. PCPs most commonly identified barriers to effective co-management of patients with CKD focused on difficulty developing working partnerships with nephrologists, including (1) lack of timely adequate information exchange (e.g., consult note not received or CKD care plan unclear); (2) unclear roles and responsibilities between PCPs and nephrologists; and (3) limited access to nephrologists (e.g., unable to obtain timely consultations or easily contact nephrologists with concerns). PCPs expressed a desire for “better communication tools” (e.g., shared electronic medical record) and clear CKD care plans to facilitate improved PCP-nephrology collaboration. Conclusions: Interventions facilitating timely adequate information exchange, clear delineation of roles and responsibilities between PCPs and nephrologists, and greater access to specialist advice may improve the co-management of patients with CKD.

AB - Background: Effective co-management of patients with chronic kidney disease (CKD) between primary care physicians (PCPs) and nephrologists is increasingly recognized as a key strategy to ensure the delivery of efficient and high-quality CKD care. However, the co-management of patients with CKD remains suboptimal. Objective: We aimed to identify PCPs’ perceptions of key barriers and facilitators to effective co-management of patients with CKD at the PCP-nephrology interface. Study Design: Qualitative study Setting and Participants: Community-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC; and San Francisco, CA Approach: We conducted four focus groups of PCPs. Two members of the research team coded transcribed audio-recorded interviews and identified major themes. Key Results: Most of the 32 PCPs (59% internists and 41% family physicians) had been in practice for > 10 years (97%), spent ≥ 80% of their time in clinical care (94%), and practiced in private (69%) or multispecialty group practice (16%) settings. PCPs most commonly identified barriers to effective co-management of patients with CKD focused on difficulty developing working partnerships with nephrologists, including (1) lack of timely adequate information exchange (e.g., consult note not received or CKD care plan unclear); (2) unclear roles and responsibilities between PCPs and nephrologists; and (3) limited access to nephrologists (e.g., unable to obtain timely consultations or easily contact nephrologists with concerns). PCPs expressed a desire for “better communication tools” (e.g., shared electronic medical record) and clear CKD care plans to facilitate improved PCP-nephrology collaboration. Conclusions: Interventions facilitating timely adequate information exchange, clear delineation of roles and responsibilities between PCPs and nephrologists, and greater access to specialist advice may improve the co-management of patients with CKD.

KW - chronic kidney disease

KW - co-management

KW - nephrology

KW - primary care

KW - qualitative research

UR - http://www.scopus.com/inward/record.url?scp=85064529865&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064529865&partnerID=8YFLogxK

U2 - 10.1007/s11606-019-04975-y

DO - 10.1007/s11606-019-04975-y

M3 - Article

C2 - 30993634

AN - SCOPUS:85064529865

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

ER -