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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Screening for chronic kidney disease in a hypertensive primary care cohort
1School of Nursing, University of Alaska Anchorage, Anchorage, Alaska.
Insights
Primary care providers need organizational support to increase chronic kidney disease (CKD) screening. Guidelines alone are insufficient for translating research into practice for CKD testing.
Area of Science:
- Health Services Research
- Primary Care Medicine
- Nephrology
Background:
- Chronic kidney disease (CKD) screening rates in primary care are low.
- Primary care providers face numerous barriers to implementing CKD testing.
- Hypertension is a key risk factor necessitating proactive screening.
Purpose of the Study:
- To investigate practice and contextual factors influencing CKD screening in hypertensive primary care patients.
- To identify barriers and facilitators for CKD screening guideline implementation.
Main Methods:
- Mixed-methods, single-embedded, convergent parallel design utilized.
- Organizational case study framework based on the Chronic Care Model.
- Data collected via electronic medical records, resource walk-throughs, and provider surveys.
Main Results:
- Low CKD screening rates observed in the study cohort.
- Patients with higher CKD risk factors were more likely to be screened.
- Organizational and community support are crucial for guideline adherence.
Conclusions:
- A holistic approach is necessary for effective guideline translation into practice.
- Primary care providers require multifaceted organizational support for CKD screening.
- Guidelines alone are insufficient for translating research into clinical practice.
Background:
Screening rates for chronic kidney disease (CKD) in primary care settings remain low. Although primary care providers are well positioned to offer this testing, there are many barriers that contribute to low screening rates.
Purpose:
The purpose of this study was to examine both practice and contextual factors that relate to screening for CKD in a cohort of primary care patients with hypertension.
Methods:
A mixed-methods, single-embedded, convergent parallel design was used for this organizational case study. The Chronic Care Model served as the framework. Electronic medical record data, resource walk-through, and provider surveys were collected from selected primary care clinics within one large academic medical center in the Pacific Northwest. Analyses included regression models, descriptive statistics, narrative content analysis, and pattern matching for organizational case creation.
Results:
Screening rates were low in the cohort, but patients with more risk factors for CKD were more likely to receive orders for screening. Organizational and community support was deemed necessary for primary care providers to effectively translate guidelines into practice.
Implications For Practice:
The results of this study offer support for a wholistic approach to guideline translation into practice. Participants in the study were open to increased screening for CKD but needed support in multiple ways from the organization. Guidelines alone were not deemed the ideal vehicles for translation of research into practice.
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