Specialist and primary care physicians' views on barriers to adequate preparation of patients for renal replacement therapy: A qualitative study

Raquel Charles Greer, Jessica M. Ameling, Kerri L. Cavanaugh, Bernard Jaar, Vanessa Grubbs, Carrie E. Andrews, Patti L Ephraim, Neil R. Powe, Julia Lewis, Ebele Umeukeje, Luis Gimenez, Sam James, Leigh Boulware

Research output: Contribution to journalArticle

Abstract

Background: Early preparation for renal replacement therapy (RRT) is recommended for patients with advanced chronic kidney disease (CKD), yet many patients initiate RRT urgently and/or are inadequately prepared. Methods: We conducted audio-recorded, qualitative, directed telephone interviews of nephrology health care providers (n=10, nephrologists, physician assistants, and nurses) and primary care physicians (PCPs, n=4) to identify modifiable challenges to optimal RRT preparation to inform future interventions. We recruited providers from public safety-net hospital-based and community-based nephrology and primary care practices. We asked providers open-ended questions to assess their perceived challenges and their views on the role of PCPs and nephrologist-PCP collaboration in patients' RRT preparation. Two independent and trained abstractors coded transcribed audio-recorded interviews and identified major themes. Results: Nephrology providers identified several factors contributing to patients' suboptimal RRT preparation, including health system resources (e.g., limited time for preparation, referral process delays, and poorly integrated nephrology and primary care), provider skills (e.g., their difficulty explaining CKD to patients), and patient attitudes and cultural differences (e.g., their poor understanding and acceptance of their CKD and its treatment options, their low perceived urgency for RRT preparation; their negative perceptions about RRT, lack of trust, or language differences). PCPs desired more involvement in preparation to ensure RRT transitions could be as "smooth as possible", including providing patients with emotional support, helping patients weigh RRT options, and affirming nephrologist recommendations. Both nephrology providers and PCPs desired improved collaboration, including better information exchange and delineation of roles during the RRT preparation process. Conclusions: Nephrology and primary care providers identified health system resources, provider skills, and patient attitudes and cultural differences as challenges to patients' optimal RRT preparation. Interventions to improve these factors may improve patients' preparation and initiation of optimal RRTs.

Original languageEnglish (US)
Article number37
JournalBMC Nephrology
Volume16
Issue number1
DOIs
StatePublished - Mar 28 2015

Fingerprint

Renal Replacement Therapy
Primary Care Physicians
Nephrology
Chronic Renal Insufficiency
Primary Health Care
Health Resources
Safety-net Providers
Interviews
Physician Assistants
Health Personnel
Language
Referral and Consultation
Nurses

Keywords

  • Collaborative care
  • Dialysis
  • Preparation
  • Primary care
  • Renal replacement therapy
  • Transplantation

ASJC Scopus subject areas

  • Nephrology

Cite this

Specialist and primary care physicians' views on barriers to adequate preparation of patients for renal replacement therapy : A qualitative study. / Greer, Raquel Charles; Ameling, Jessica M.; Cavanaugh, Kerri L.; Jaar, Bernard; Grubbs, Vanessa; Andrews, Carrie E.; Ephraim, Patti L; Powe, Neil R.; Lewis, Julia; Umeukeje, Ebele; Gimenez, Luis; James, Sam; Boulware, Leigh.

In: BMC Nephrology, Vol. 16, No. 1, 37, 28.03.2015.

Research output: Contribution to journalArticle

Greer, Raquel Charles ; Ameling, Jessica M. ; Cavanaugh, Kerri L. ; Jaar, Bernard ; Grubbs, Vanessa ; Andrews, Carrie E. ; Ephraim, Patti L ; Powe, Neil R. ; Lewis, Julia ; Umeukeje, Ebele ; Gimenez, Luis ; James, Sam ; Boulware, Leigh. / Specialist and primary care physicians' views on barriers to adequate preparation of patients for renal replacement therapy : A qualitative study. In: BMC Nephrology. 2015 ; Vol. 16, No. 1.
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T2 - A qualitative study

AU - Greer, Raquel Charles

AU - Ameling, Jessica M.

AU - Cavanaugh, Kerri L.

AU - Jaar, Bernard

AU - Grubbs, Vanessa

AU - Andrews, Carrie E.

AU - Ephraim, Patti L

AU - Powe, Neil R.

AU - Lewis, Julia

AU - Umeukeje, Ebele

AU - Gimenez, Luis

AU - James, Sam

AU - Boulware, Leigh

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KW - Collaborative care

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KW - Renal replacement therapy

KW - Transplantation

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