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

• Type of Material: Article
• Authors: C. John Sperati, Johns Hopkins University; Sandeep Soman, Henry Ford Hospital; Varun Agrawal, University of Vermont; Yang Liu, Emory University; Khaled Abdel-Kader, Vanderbilt University; Clarissa J. Diamantidis, Duke University; Michelle M. Estrella, University of California, San Francisco; Kerri Cavanaugh, Vanderbilt University; Laura Plantinga, Emory University; Jane Schell, University of Pittsburgh; James Simon, Cleveland Clinic Foundation; Joseph A. Vassalotti, Icahn School of Medicine; Michael J. Choi, Johns Hopkins University; Bernard G. Jaar, Johns Hopkins University; Raquel C. Greer, Welch Center for Prevention, Epidemiology and Clinical Research
• Language: English
• Date: 2019-01-01
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
• License: Creative Commons Creative Commons CC0 1.0 Universal
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0221325
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 14
• Issue: 8
• Start Page: e0221325
• End Page: e0221325
• Grant/Funding Information: This work was supported by the National Kidney Foundation of Maryland and the National Kidney Foundation.; The work was also supported by the National Institutes of Health grant K23DK094975 (Greer); and R01DK103935-01A1 (Cavanaugh); and the Johns Hopkins Doris Duke Early Clinician Investigator Award (Greer).
• Research Categories: Health Sciences, Medicine and Surgery

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.