Helen Tam-Tham1, Kathryn M King-Shier1,2, Chandra M Thomas3, Robert R Quinn1,3, Karen Fruetel3, Sara N Davison4, Brenda R Hemmelgarn5,3. 1. Departments of Community Health Sciences and. 2. Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; and. 3. Medicine, Cumming School of Medicine and. 4. Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. 5. Departments of Community Health Sciences and Brenda.Hemmelgarn@ahs.ca.
Abstract
BACKGROUND AND OBJECTIVES: Conservative management of adults with stage 5 CKD (eGFR<15 ml/min per 1.73 m2) is increasingly being provided in the primary care setting. We aimed to examine perceived barriers and facilitators for conservative management of older adults by primary care physicians. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In 2015, we conducted a cross-sectional, population-based survey of all primary care physicians in Alberta, Canada. Eligible participants had experience caring for adults ages ≥75 years old with stage 5 CKD not planning on initiating dialysis. Questionnaire items were on the basis of a qualitative descriptive study informed by the Behavior Change Wheel and tested for face and content validity. Physicians were contacted via postal mail and/or fax on the basis of a modified Dillman method. RESULTS: Four hundred nine eligible primary care physicians completed the questionnaire (9.6% response rate). The majority of respondents were men (61.6%), were ages 40-60 years old (62.6%), and practiced in a large/medium population center (68.0%). The most common barrier to providing conservative care in the primary care setting was the inability to access support to maintain patients in the home setting (39.1% of respondents; 95% confidence interval, 34.6% to 43.6%). The second most common barrier was working with nonphysician providers with limited kidney-specific clinical expertise (32.3%; 95% confidence interval, 28.0% to 36.7%). Primary care physicians indicated that the two most common strategies that would enhance their ability to provide conservative management would be the ability to use the telephone to contact a nephrologist or clinical staff from the conservative care clinic (86.9%; 95% confidence interval, 83.7% to 90.0% and 85.6%; 95% confidence interval, 82.4% to 88.9%, respectively). CONCLUSIONS: We identified important areas to inform clinical programs to reduce barriers and enhance facilitators to improve primary care physicians' provision of conservative kidney care. In particular, primary care physicians require additional resources for maintaining patients in their home and telephone access to nephrologists and conservative care specialists.
BACKGROUND AND OBJECTIVES: Conservative management of adults with stage 5 CKD (eGFR<15 ml/min per 1.73 m2) is increasingly being provided in the primary care setting. We aimed to examine perceived barriers and facilitators for conservative management of older adults by primary care physicians. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In 2015, we conducted a cross-sectional, population-based survey of all primary care physicians in Alberta, Canada. Eligible participants had experience caring for adults ages ≥75 years old with stage 5 CKD not planning on initiating dialysis. Questionnaire items were on the basis of a qualitative descriptive study informed by the Behavior Change Wheel and tested for face and content validity. Physicians were contacted via postal mail and/or fax on the basis of a modified Dillman method. RESULTS: Four hundred nine eligible primary care physicians completed the questionnaire (9.6% response rate). The majority of respondents were men (61.6%), were ages 40-60 years old (62.6%), and practiced in a large/medium population center (68.0%). The most common barrier to providing conservative care in the primary care setting was the inability to access support to maintain patients in the home setting (39.1% of respondents; 95% confidence interval, 34.6% to 43.6%). The second most common barrier was working with nonphysician providers with limited kidney-specific clinical expertise (32.3%; 95% confidence interval, 28.0% to 36.7%). Primary care physicians indicated that the two most common strategies that would enhance their ability to provide conservative management would be the ability to use the telephone to contact a nephrologist or clinical staff from the conservative care clinic (86.9%; 95% confidence interval, 83.7% to 90.0% and 85.6%; 95% confidence interval, 82.4% to 88.9%, respectively). CONCLUSIONS: We identified important areas to inform clinical programs to reduce barriers and enhance facilitators to improve primary care physicians' provision of conservative kidney care. In particular, primary care physicians require additional resources for maintaining patients in their home and telephone access to nephrologists and conservative care specialists.
Authors: Ann M O'Hare; Rudolph A Rodriguez; Susan M Hailpern; Eric B Larson; Manjula Kurella Tamura Journal: JAMA Date: 2010-07-14 Impact factor: 56.272
Authors: Marisha Burden; Ellen Sarcone; Angela Keniston; Barbara Statland; Julie A Taub; Rebecca L Allyn; Mark B Reid; Lilia Cervantes; Maria G Frank; Nicholas Scaletta; Philip Fung; Smitha R Chadaga; Katarzyna Mastalerz; Nancy Maller; Margherita Mascolo; Jeff Zoucha; Jessica Campbell; Mary P Maher; Sarah A Stella; Richard K Albert Journal: J Hosp Med Date: 2012-10-12 Impact factor: 2.960
Authors: Sara N Davison; Adeera Levin; Alvin H Moss; Vivekanand Jha; Edwina A Brown; Frank Brennan; Fliss E M Murtagh; Saraladevi Naicker; Michael J Germain; Donal J O'Donoghue; Rachael L Morton; Gregorio T Obrador Journal: Kidney Int Date: 2015-04-29 Impact factor: 10.612
Authors: Tim Luckett; Marcus Sellars; Jennifer Tieman; Carol A Pollock; William Silvester; Phyllis N Butow; Karen M Detering; Frank Brennan; Josephine M Clayton Journal: Am J Kidney Dis Date: 2014-01-14 Impact factor: 8.860
Authors: Andrew D Beswick; Karen Rees; Paul Dieppe; Salma Ayis; Rachael Gooberman-Hill; Jeremy Horwood; Shah Ebrahim Journal: Lancet Date: 2008-03-01 Impact factor: 79.321