Primary Care Physicians' Perceived Barriers to Nephrology Referral and Co-management of Patients with CKD: a Qualitative Study
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Raquel C Greer1,2, Yang Liu3,4, Kerri Cavanaugh5,6
1The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA. rgreer@jhmi.edu.
Insights
Primary care physicians find co-management of chronic kidney disease (CKD) challenging due to poor communication and unclear roles. Improving information exchange and defining responsibilities can enhance CKD patient care between PCPs and nephrologists.
Area of Science:
- Nephrology
- Primary Care Medicine
- Healthcare Management
Background:
- Effective co-management between primary care physicians (PCPs) and nephrologists is crucial for high-quality chronic kidney disease (CKD) care.
- Current co-management practices for CKD patients are often suboptimal, indicating a need for improvement.
Purpose of the Study:
- To identify primary care physicians' (PCPs) perceived barriers and facilitators to effective co-management of chronic kidney disease (CKD) patients.
- To understand the PCP-nephrology interface challenges from the PCP perspective.
Main Methods:
- A qualitative study involving four focus groups with community-based PCPs across four US cities.
- Transcribed interviews were coded by researchers to identify major themes regarding CKD co-management.
Main Results:
- PCPs identified significant barriers including lack of timely information exchange, unclear roles and responsibilities, and limited access to nephrologists.
- Specific issues cited were unreceived consult notes, unclear CKD care plans, and difficulty contacting specialists.
- PCPs desired better communication tools, such as shared electronic medical records, and clearer care plans.
Conclusions:
- Interventions should focus on improving timely information exchange between PCPs and nephrologists.
- Clear delineation of roles and responsibilities is essential for effective CKD co-management.
- Enhanced access to specialist advice and improved communication tools can optimize collaborative CKD care.
Background:
Effective co-management of patients with chronic kidney disease (CKD) between primary care physicians (PCPs) and nephrologists is increasingly recognized as a key strategy to ensure the delivery of efficient and high-quality CKD care. However, the co-management of patients with CKD remains suboptimal.
Objective:
We aimed to identify PCPs' perceptions of key barriers and facilitators to effective co-management of patients with CKD at the PCP-nephrology interface.
Study Design:
Qualitative study SETTING AND PARTICIPANTS: Community-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC; and San Francisco, CA APPROACH: We conducted four focus groups of PCPs. Two members of the research team coded transcribed audio-recorded interviews and identified major themes.
Key Results:
Most of the 32 PCPs (59% internists and 41% family physicians) had been in practice for > 10 years (97%), spent ≥ 80% of their time in clinical care (94%), and practiced in private (69%) or multispecialty group practice (16%) settings. PCPs most commonly identified barriers to effective co-management of patients with CKD focused on difficulty developing working partnerships with nephrologists, including (1) lack of timely adequate information exchange (e.g., consult note not received or CKD care plan unclear); (2) unclear roles and responsibilities between PCPs and nephrologists; and (3) limited access to nephrologists (e.g., unable to obtain timely consultations or easily contact nephrologists with concerns). PCPs expressed a desire for "better communication tools" (e.g., shared electronic medical record) and clear CKD care plans to facilitate improved PCP-nephrology collaboration.
Conclusions:
Interventions facilitating timely adequate information exchange, clear delineation of roles and responsibilities between PCPs and nephrologists, and greater access to specialist advice may improve the co-management of patients with CKD.