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

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 facilitator...

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Veröffentlicht in:	PloS one Jg. 14; H. 8; S. e0221325
Hauptverfasser:	Sperati, C. John, Soman, Sandeep, Agrawal, Varun, Liu, Yang, Abdel-Kader, Khaled, Diamantidis, Clarissa J., Estrella, Michelle M., Cavanaugh, Kerri, Plantinga, Laura, Schell, Jane, Simon, James, Vassalotti, Joseph A., Choi, Michael J., Jaar, Bernard G., Greer, Raquel C.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States Public Library of Science 22.08.2019 Public Library of Science (PLoS)
Schlagworte:	Analysis Attitude of Health Personnel Audio data Beliefs, opinions and attitudes Care and treatment Chronic kidney failure Cities Cities and towns Clinical trials Collaboration Communication Barriers Diabetes Disease control Disease Management Education Electronic health records Electronic medical records Electronic records Epidemiology Female Focus Groups Guidelines Health care Health care reform Health Knowledge, Attitudes, Practice Humans Hypertension Internal medicine Kidney diseases Kidneys Male Management Medical personnel Medical records Medical research Medicine Medicine and Health Sciences Middle Aged Mixed methods research Nephrology Patient Compliance - psychology Patient Compliance - statistics & numerical data Patients People and Places Physicians Physicians, Primary Care - psychology Practice Guidelines as Topic Practice Patterns, Physicians' - statistics & numerical data Prevalence studies (Epidemiology) Primary care Public health Renal Insufficiency, Chronic - diagnosis Renal Insufficiency, Chronic - physiopathology Renal Insufficiency, Chronic - therapy Risk factors Social Sciences Surveys and Questionnaires Time Factors United States United States Cities Maryland New York San Francisco California United States > US Tennessee California Nashville Tennessee Baltimore Maryland
ISSN:	1932-6203, 1932-6203
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Zusammenfassung:	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. Mixed methods study. Community-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC and San Francisco, CA. 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. 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. 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. 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.
Bibliographie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Membership of the National Kidney Foundation Education Committee are listed as authors of the manuscript Competing Interests: The authors have declared that no competing interests exist. These authors are co-first authors on this work.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0221325