Guidelines or mindlines? - implementing a new CKD guideline in German primary care

Area of Science:

• Primary Care Medicine
• Clinical Guideline Implementation
• Nephrology Practice

Background:

• Clinical guidelines are crucial for improving chronic kidney disease (CKD) management in primary care.
• The German College of General Practitioners and Family Physicians (DEGAM) published the first CKD guideline for German GPs in 2019.

Purpose of the Study:

• To identify barriers and enablers for implementing the DEGAM CKD guideline among general practitioners (GPs).
• To inform an update of the guideline based on identified implementation challenges and successes.

Main Methods:

• 17 semi-structured interviews were conducted with GPs in Berlin and Brandenburg.
• Qualitative content analysis, following Mayring's methodology, was used to analyze interview transcripts.

Main Results:

• Significant barriers included low perceived clinical priority of CKD, opportunity costs, and poor patient understanding.
• Enablers suggested by GPs were improved graphic design and integration into clinical decision support systems.
• GPs primarily relied on informal communication with specialists for CKD management, rarely consulting guidelines.

Conclusions:

• Guidelines were not utilized as step-by-step decision aids during patient consultations, representing a key barrier.
• Informal communication between primary and secondary care serves as a vital channel for evidence-based CKD information in Germany.
• Implementation initiatives should focus on strengthening primary-secondary care relationships for better guideline uptake.