It is time to educate primary care physicians on the signs of CKD
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Results of a newly released study by Johns Hopkins Medicine researchers and others show why HHS Secretary Alex M. Azar II’s goal of reducing the cases of ESKD by 25% during the next 10 years may be difficult.
In a series of focus groups, primary care physicians said they believed they lacked the knowledge, time and clinical support tools to identify and care for patients with chronic kidney disease. The study was sponsored by the National Kidney Foundation.
The researchers categorized 32 participating physicians from Baltimore; St. Louis; Raleigh, North Carolina and San Francisco into four focus groups. The physicians first took a brief, self-administered questionnaire about their demographic and medical practice characteristics. Results showed 22 of the participants were in private practice and 20 treated between zero and 20 patients with CKD per week, while the remaining 12 saw more than 20 patients with CKD per week.
The 90-minute focus group sessions generated responses to questions about perceived barriers and aids to care for patients with CKD. Almost 85% of the primary care physicians said they were comfortable managing patients with early stage CKD, but were not comfortable managing specific complications, such as anemia (44%), bone (72%) and metabolic (69%) disorders.
“Most cited a lack of access to clinical resources such as clinical information systems and insufficient patient education material about CKD as reasons for their lack of confidence,” according to the release. “Physicians cited a lack of adequate time to spend with patients and identified health care system-level barriers, such as poor reimbursement for delivering care to medically complex CKD patients. These challenges contribute to limited visit times and high out-of-pocket costs for patients.”
In the focus group discussions, PCPs also identified patient-level barriers to effective management, such as patients having a limited understanding of the implications of CKD and the financial challenges associated with needing medications, tests and other health costs.
John Sperati, MD, associate professor of medicine at the Johns Hopkins University School of Medicine and director of the school’s Nephrology Fellowship Training Program who lead the research, said physicians in the focus group also emphasized a need for CKD guidelines that were easier to implement: 14 of the 31 PCPs said they did not follow guidelines. Asked to identify what could help them most, the focus group physicians cited access to automatic eGFR reports to screen for low levels of GFR; clear, concise guidelines for treatment; better education; and improved insurance coverage and physician reimbursement for services and care.
“This is helpful information in identifying what primary care physicians see as barriers but also as potential solutions,” Sperati said in the release.
Indeed, if we are to go after the major causes of kidney failure — high blood pressure and diabetes, now estimated by public health officials to affect 15% of the adult population — as a way to slow the march to kidney disease and reduce the high costs of dialysis, education and prevention will be important tools for those engaged in the fight against the progression of kidney disease (click here to see the article by Barry H. Smith, MD, PhD).
“If we can slow down progression of kidney disease through the earlier stages, it may have a meaningful impact on those complications that can develop, like cardiovascular disease and other health issues,” Sperati said in the release. “If we hope to reduce the personal and financial toll of CKD and end-stage kidney failure, primary care physicians must be key players, and we as kidney specialists need to form better partnerships with PCPs and need to offer more training and resources to them.”
- Reference:
- Sperati CJ, et al. PLoS ONE. 2019; doi.org/10.1371/journal.pone.0221325.