Format

Send to

Choose Destination
BMC Fam Pract. 2018 Jun 6;19(1):81. doi: 10.1186/s12875-018-0736-3.

General practitioners' perspectives on management of early-stage chronic kidney disease: a focus group study.

Author information

1
Department of Primary and Community Care, Radboud University Medical Center, PO Box 9101, 6500 HB, Postal Route 117, Nijmegen, The Netherlands. Carola.vanDipten@radboudumc.nl.
2
Department of Primary and Community Care, Radboud University Medical Center, PO Box 9101, 6500 HB, Postal Route 117, Nijmegen, The Netherlands.
3
Department of Nephrology, Radboud University Medical Center, PO Box 9101, 6500 HB, Postal Route 464, Nijmegen, The Netherlands.

Abstract

BACKGROUND:

Guideline adherence in chronic kidney disease management is low, despite guideline implementation initiatives. Knowing general practitioners' (GPs') perspectives of management of early-stage chronic kidney disease (CKD) and the applicability of the national interdisciplinary guideline could support strategies to improve quality of care.

METHOD:

Qualitative focus group study with 27 GPs in the Netherlands. Three analysts open-coded and comparatively analysed the data. Mind-mapping sessions were performed after data-saturation.

RESULTS:

Five themes emerged: defining CKD, knowledge and awareness, patient-physician interaction, organisation of CKD care and value of the guideline. A key finding was the abstractness of the CKD concept. The GPs expressed various perspectives about defining CKD and interpreting estimated glomerular filtration rates. Views about clinical relevance influenced the decision-making, although factual knowledge seems lacking. Striving to inform well enough without creating anxiety and to explain suitably for the intellectual ability of the patient caused tension in the patient-physician interaction. Integration with cardiovascular disease-management programmes was mentioned as a way of implementing CKD care in the future. The guideline was perceived as a rough guide rather than a leading document.

CONCLUSION:

CKD is perceived as an abstract rather than a clinical concept. Abstractness plays a role in all formulated themes. Management of CKD patients in primary care is complex and is influenced by physician-bound considerations related to individual knowledge and perception of the importance of CKD. Strategies are needed to improve GPs' understanding of the concept of CKD by education, a holistic approach to guidelines, and integration of CKD care into cardiovascular programmes.

TRIAL REGISTRATION:

Not applicable.

KEYWORDS:

Chronic kidney disease; Guidelines; Primary care; Qualitative research; Quality of care

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center