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Primary care physicians, nephrologists identify barriers in co-management of patients with CKD
In a study supported by the National Kidney Foundation, primary care physicians identified several central barriers to providing the highest quality of care to patients with chronic kidney disease, which focused on challenges in co-management with nephrologists.
“Effective co-management of patients with CKD is increasingly recognized as a key strategy to ensure the delivery of efficient, high-quality and safe care,” Raquel C. Greer, MD, MHS, of the Welch Center for Prevention, Epidemiology and Clinical Research and the division of general internal medicine at Johns Hopkins University in Baltimore, and colleagues wrote. “Primary care and nephrology providers are two key participants responsible for managing patients’ risks for CKD progression and CKD-related complications, and [both] desire improved co-management of patients.”
To explore the perceptions of primary care physicians regarding what barriers exist that contribute to suboptimal co-management of patients with CKD, researchers conducted a qualitative study in which they administered four focus groups to 32 primary care physicians (59% were internists; 41% were family physicians; 97% in practice for more than 10 years; 16% practiced in multispecialty group settings).
The focus groups, based in four U.S. cities and taking place between April and June 2015, centered on both the perceived barriers and views of potential tools and resources that could be used to improve the co-managed care. Each group lasted 90 minutes and was audio-recorded.
Researchers found the most common barriers identified by primary care physicians were related to the difficulty of developing working partnerships with nephrologists due to a lack of timely and adequate information exchange, unclear roles and responsibilities between the two, limited access to nephrologists and the lack of established relationships and trust between patients and nephrologists.
Primary care physicians also described the most effective collaborations they had experienced with nephrologists as those where the nephrologist was easily accessible, offered timely appointments and provided comprehensive care plans. Thus, primary care physicians suggested developing “better communication tools,” such as shared electronic medical records, and clear care plans as tools to improve co-management.
The researchers concluded that the identified barriers are all modifiable.
“The findings from this study can inform interventions to improve the efficiency, quality and safety of co-managed care of CKD, and are also generalizable to other chronic illnesses,” they wrote. – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.