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Kidney failure risk equation (KFRE), A risk-based triage for nephrology referrals: A mixed-methods study at
Nur Raziana Rozi1, Christine Shamala Selvaraj2, Jia-Kai Tan3
1Department of Medicine, Kulliyyah of Medicine, International Islamic University Malaysia (IIUM), Kuantan, Malaysia.
Insights
Healthcare providers identified patient insight gaps and system shortfalls as key barriers to managing chronic kidney disease (CKD). Implementing the kidney failure risk equation (KFRE) may improve targeted nephrology referrals and patient outcomes.
Area of Science:
- Nephrology
- Public Health
- Healthcare Management
Background:
- Chronic kidney disease (CKD) is a global health concern with limited understanding of healthcare provider (HCP) perspectives on management.
- Exploring facilitators and barriers to CKD management is crucial for improving patient care.
- Integrating risk-based triage tools like the kidney failure risk equation (KFRE) can enhance referral processes.
Purpose of the Study:
- To explore HCPs' perspectives on facilitators and barriers to CKD management.
- To assess perceived benefits and challenges of implementing the KFRE for nephrology referrals.
- To identify strategies for enhancing CKD care before KFRE implementation.
Main Methods:
- Mixed methods approach combining semi-structured interviews and job satisfaction surveys.
- Thematic analysis of transcribed interviews with 27 HCPs across primary care, nephrology, and endocrinology.
- Quantitative survey data collected from 111 HCPs at Universiti Malaya Medical Centre.
Main Results:
- Top barriers to CKD management include suboptimal patient insights, practice gaps, and healthcare system shortfalls.
- Key facilitators include strong interdisciplinary networks and access to specialist resources.
- HCPs perceived the KFRE as a potentially useful tool for targeted nephrology referrals.
Conclusions:
- Addressing modifiable barriers and leveraging facilitators can improve CKD patient outcomes.
- The KFRE shows promise for facilitating targeted nephrology referrals and optimizing resource allocation.
- Enhanced interdisciplinary collaboration and patient education are vital for effective CKD management.
Background:
Chronic kidney disease (CKD) poses a significant health challenge globally. There is limited understanding of the challenges and opportunities to enhance CKD management from the perspectives of healthcare providers (HCPs) involved in the direct care of patients with CKD. To integrate a risk-based triage for nephrology referrals, namely the kidney failure risk equation (KFRE), we explored HCPs' perspectives on the facilitators and barriers to CKD management before the implementation of KFRE.
Methods:
We used a mixed methods approach to explore HCPs' perspectives on the 1) facilitators and barriers to CKD management and 2) perceived benefits and challenges of implementing KFRE, a risk-based triage to guide nephrology referrals at the Universiti Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. Interviews were audio recorded, transcribed verbatim, and thematically analyzed. Quantitatively, provider job satisfaction surveys were performed.
Results:
Overall, 111 HCPs completed the surveys, with the majority being mostly satisfied with the physical surroundings, co-workers, and supervision received. Mixed responses were expressed about the amount of work and equipment provided. Interviews were conducted among 27 HCPs from the three main CKD care provider groups (primary care medicine, nephrology, and endocrinology). The facilitators' and barriers' themes were identified. The top three barriers to CKD management were suboptimal patients' insights, gaps in practices and confidences, and shortfalls in the healthcare system. By contrast, a good interdisciplinary network and accessibility to specialist resources were the key facilitators. They underscored the importance of human resources empowerment, continuous patient education, and structured interdisciplinary collaboration. HCPs perceived risk-based triage using the KFRE as potentially useful for more targeted care.
Conclusion:
We identified several modifiable barriers and facilitators warranting attention to improve the health outcomes of people with CKD. A risk-based triage approach using the KFRE appears promising in facilitating targeted nephrology referrals for better care and resource allocations.
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