Using chronic kidney disease trigger tools for safety and learning: a qualitative evaluation in East London primary care
| Autor: | Nicola Thomas, Sally Hull, Vian Rajabzadeh |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male tool use behaviour Quality management Referral Attitude of Health Personnel Project commissioning 030232 urology & nephrology primary care 03 medical and health sciences Patient safety 0302 clinical medicine Nursing General Practitioners London patient safety Electronic Health Records Humans Medicine 030212 general & internal medicine Renal Insufficiency Chronic Referral and Consultation Qualitative Research Aged Aged 80 and over trigger tools Primary Health Care business.industry Research Middle Aged medicine.disease Quality Improvement chronic kidney diseases Workflow Disease Progression Female Thematic analysis Family Practice business Glomerular Filtration Rate Kidney disease Qualitative research |
| Zdroj: | Br J Gen Pract |
| ISSN: | 1478-5242 0960-1643 |
| DOI: | 10.3399/bjgp19x705497 |
| Popis: | BackgroundAn innovative programme to improve identification and management of chronic kidney disease (CKD) in primary care was implemented across three clinical commissioning groups (CCGs) in 2016. This included a falling estimated glomerular filtration rate (eGFR) trigger tool built from data in the electronic health record (EHR). This tool notifies GP practices of falling eGFR values. By alerting clinicians to patients with possible CKD progression the tool invites clinical review, a referral option, and written reflection on management.AimTo identify practitioner perceptions of trigger tool use from interviews, and compare these with reflections on clinical management recorded within the tools.Design and settingA qualitative analysis set in 136 practices across East London during 2016–2018.MethodEight semi-structured interviews with GPs and practice staff were recorded, and thematic analysis was undertaken using framework analysis. The reflective comments recorded in the trigger tools of 1921 cases were categorised by age group, referral status, and by the drop in eGFR (>15 or >25 ml/min).ResultsThree themes emerged from the interviews: getting started, patient safety, and trigger tools for learning. Well-organised practices found the tool was readily embedded into workflow and expressed greater motivation for using it. The tool was seen to support patient safety, and was used for learning about CKD management, both individually and as a practice. Reflective comments from 1921 trigger tools were reviewed. These supported the theme of patient safety. The free-text data, stratified by age, challenged the expectation that younger cases, at higher risk of progressive CKD, would have higher referral rates.ConclusionBuilding electronic trigger tools from the EHR can identify patients with a falling eGFR, prompting review of the eGFR trajectory and management plan. Interview and reflective data illustrated that practice use of the tool supports the patient safety agenda and encourages learning about CKD management. |
| Databáze: | OpenAIRE |
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