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 C.
AU - Liu, Yang
AU - Cavanaugh, Kerri
AU - Diamantidis, Clarissa Jonas
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 G.
AU - Choi, Michael J.
N1 - Publisher Copyright:
© 2019, Society of General Internal Medicine.
PY - 2019/7/15
Y1 - 2019/7/15
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
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U2 - 10.1007/s11606-019-04975-y
DO - 10.1007/s11606-019-04975-y
M3 - Article
C2 - 30993634
AN - SCOPUS:85064529865
SN - 0884-8734
VL - 34
SP - 1228
EP - 1235
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 7
ER -