Primary care physicians’ perceptions of barriers and facilitators to management of chronic kidney disease: A mixed methods study

on behalf of the National Kidney Foundation Education Committee¶

Research output: Contribution to journalArticle

Abstract

Background Given the high prevalence of chronic kidney disease (CKD), primary care physicians (PCPs) frequently manage early stage CKD. Nonetheless, there are challenges in providing optimal CKD care in the primary care setting. This study sought to understand PCPs’ perceptions of barriers and facilitators to the optimal management of CKD. Study design Mixed methods study Settings and participants Community-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC and San Francisco, CA. Methodology We used a self-administered questionnaire and conducted 4 focus groups of PCPs (n = 8 PCPs/focus group) in each city to identify key barriers and facilitators to management of patients with CKD in primary care. Analytic approach We conducted descriptive analyses of the survey data. Major themes were identified from audio-recorded interviews that were transcribed and coded by the research team. Results Of 32 participating PCPs, 31 (97%) had been in practice for >10 years, and 29 (91%) practiced in a non-academic setting. PCPs identified multiple barriers to managing CKD in primary care including at the level of the patient (e.g., low awareness of CKD, poor adherence to treatment recommendations), the provider (e.g., staying current with CKD guidelines), and the health care system (e.g., inflexible electronic medical record, limited time and resources). PCPs desired electronic prompts and lab decision support, concise guidelines, and healthcare financing reform to improve CKD care. Conclusions PCPs face substantial but modifiable barriers in providing care to patients with CKD. Interventions that address these barriers and promote facilitative tools may improve PCPs’ effectiveness and capacity to care for patients with CKD.

Original languageEnglish (US)
Article numbere0221325
JournalPloS one
Volume14
Issue number8
DOIs
StatePublished - Jan 1 2019

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Primary Care Physicians
kidney diseases
Chronic Renal Insufficiency
physicians
methodology
Primary Health Care
focus groups
Focus Groups
health services
electronics
Patient Care
Guidelines
Healthcare Financing
Electronic medical equipment
Baltimore
Health Care Reform
patient care
San Francisco
Electronic Health Records
Health care

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Primary care physicians’ perceptions of barriers and facilitators to management of chronic kidney disease : A mixed methods study. / on behalf of the National Kidney Foundation Education Committee¶.

In: PloS one, Vol. 14, No. 8, e0221325, 01.01.2019.

Research output: Contribution to journalArticle

on behalf of the National Kidney Foundation Education Committee¶. / Primary care physicians’ perceptions of barriers and facilitators to management of chronic kidney disease : A mixed methods study. In: PloS one. 2019 ; Vol. 14, No. 8.
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title = "Primary care physicians’ perceptions of barriers and facilitators to management of chronic kidney disease: A mixed methods study",
abstract = "Background Given the high prevalence of chronic kidney disease (CKD), primary care physicians (PCPs) frequently manage early stage CKD. Nonetheless, there are challenges in providing optimal CKD care in the primary care setting. This study sought to understand PCPs’ perceptions of barriers and facilitators to the optimal management of CKD. Study design Mixed methods study Settings and participants Community-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC and San Francisco, CA. Methodology We used a self-administered questionnaire and conducted 4 focus groups of PCPs (n = 8 PCPs/focus group) in each city to identify key barriers and facilitators to management of patients with CKD in primary care. Analytic approach We conducted descriptive analyses of the survey data. Major themes were identified from audio-recorded interviews that were transcribed and coded by the research team. Results Of 32 participating PCPs, 31 (97{\%}) had been in practice for >10 years, and 29 (91{\%}) practiced in a non-academic setting. PCPs identified multiple barriers to managing CKD in primary care including at the level of the patient (e.g., low awareness of CKD, poor adherence to treatment recommendations), the provider (e.g., staying current with CKD guidelines), and the health care system (e.g., inflexible electronic medical record, limited time and resources). PCPs desired electronic prompts and lab decision support, concise guidelines, and healthcare financing reform to improve CKD care. Conclusions PCPs face substantial but modifiable barriers in providing care to patients with CKD. Interventions that address these barriers and promote facilitative tools may improve PCPs’ effectiveness and capacity to care for patients with CKD.",
author = "{on behalf of the National Kidney Foundation Education Committee¶} and Sperati, {C John} and Sandeep Soman and Varun Agrawal and Yang Liu and Khaled Abdel-Kader and Clarissa Diamantidis and Estrella, {Michelle M.} and Kerri Cavanaugh and Laura Plantinga and Jane Schell and James Simon and Vassalotti, {Joseph A.} and Choi, {Michael J.} and Bernard Jaar and Greer, {Raquel Charles}",
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T1 - Primary care physicians’ perceptions of barriers and facilitators to management of chronic kidney disease

T2 - A mixed methods study

AU - on behalf of the National Kidney Foundation Education Committee¶

AU - Sperati, C John

AU - Soman, Sandeep

AU - Agrawal, Varun

AU - Liu, Yang

AU - Abdel-Kader, Khaled

AU - Diamantidis, Clarissa

AU - Estrella, Michelle M.

AU - Cavanaugh, Kerri

AU - Plantinga, Laura

AU - Schell, Jane

AU - Simon, James

AU - Vassalotti, Joseph A.

AU - Choi, Michael J.

AU - Jaar, Bernard

AU - Greer, Raquel Charles

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N2 - Background Given the high prevalence of chronic kidney disease (CKD), primary care physicians (PCPs) frequently manage early stage CKD. Nonetheless, there are challenges in providing optimal CKD care in the primary care setting. This study sought to understand PCPs’ perceptions of barriers and facilitators to the optimal management of CKD. Study design Mixed methods study Settings and participants Community-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC and San Francisco, CA. Methodology We used a self-administered questionnaire and conducted 4 focus groups of PCPs (n = 8 PCPs/focus group) in each city to identify key barriers and facilitators to management of patients with CKD in primary care. Analytic approach We conducted descriptive analyses of the survey data. Major themes were identified from audio-recorded interviews that were transcribed and coded by the research team. Results Of 32 participating PCPs, 31 (97%) had been in practice for >10 years, and 29 (91%) practiced in a non-academic setting. PCPs identified multiple barriers to managing CKD in primary care including at the level of the patient (e.g., low awareness of CKD, poor adherence to treatment recommendations), the provider (e.g., staying current with CKD guidelines), and the health care system (e.g., inflexible electronic medical record, limited time and resources). PCPs desired electronic prompts and lab decision support, concise guidelines, and healthcare financing reform to improve CKD care. Conclusions PCPs face substantial but modifiable barriers in providing care to patients with CKD. Interventions that address these barriers and promote facilitative tools may improve PCPs’ effectiveness and capacity to care for patients with CKD.

AB - Background Given the high prevalence of chronic kidney disease (CKD), primary care physicians (PCPs) frequently manage early stage CKD. Nonetheless, there are challenges in providing optimal CKD care in the primary care setting. This study sought to understand PCPs’ perceptions of barriers and facilitators to the optimal management of CKD. Study design Mixed methods study Settings and participants Community-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC and San Francisco, CA. Methodology We used a self-administered questionnaire and conducted 4 focus groups of PCPs (n = 8 PCPs/focus group) in each city to identify key barriers and facilitators to management of patients with CKD in primary care. Analytic approach We conducted descriptive analyses of the survey data. Major themes were identified from audio-recorded interviews that were transcribed and coded by the research team. Results Of 32 participating PCPs, 31 (97%) had been in practice for >10 years, and 29 (91%) practiced in a non-academic setting. PCPs identified multiple barriers to managing CKD in primary care including at the level of the patient (e.g., low awareness of CKD, poor adherence to treatment recommendations), the provider (e.g., staying current with CKD guidelines), and the health care system (e.g., inflexible electronic medical record, limited time and resources). PCPs desired electronic prompts and lab decision support, concise guidelines, and healthcare financing reform to improve CKD care. Conclusions PCPs face substantial but modifiable barriers in providing care to patients with CKD. Interventions that address these barriers and promote facilitative tools may improve PCPs’ effectiveness and capacity to care for patients with CKD.

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