Chronic Kidney Disease Guideline Implementation in Primary Care: A Qualitative Report from the TRANSLATE CKD Study
| Autor: | Chester H. Fox, Jessica Sand, Trevor R. M. York, Bonnie M. Vest, Linda S. Kahn |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Normalization process theory Attitude of Health Personnel Alternative medicine Psychological intervention Physicians Primary Care Article Nursing medicine Humans Cluster randomised controlled trial Renal Insufficiency Chronic Disease management (health) Qualitative Research Retrospective Studies Primary Health Care business.industry Public Health Environmental and Occupational Health Disease Management medicine.disease United States Female Thematic analysis Family Practice business Kidney disease Qualitative research |
| Zdroj: | The Journal of the American Board of Family Medicine. 28:624-631 |
| ISSN: | 1558-7118 1557-2625 |
| DOI: | 10.3122/jabfm.2015.05.150070 |
| Popis: | Background: Primary care physicians (PCPs) are optimally situated to identify and manage early stage chronic kidney disease (CKD). Nonetheless, studies have documented suboptimal PCP understanding, awareness, and management of early CKD. The TRANSLATE CKD study is an ongoing national, mixed-methods, cluster randomized control trial that examines the implementation of evidence-based guidelines for CKD into primary care practice. Methods: As part of the mixed-methods process evaluation, semistructured interviews were conducted by phone with 27 providers participating in the study. Interviews were audio-taped and transcribed. Thematic content analysis was used to identify themes. Themes were categorized according to the 4 domains of Normalization Process Theory (NPT). Results: Identified themes illuminated the complex work undertaken to manage CKD in primary care practices. Barriers to guideline implementation were identified in each of the 4 NPT domains, including (1) lack of knowledge and understanding around CKD (coherence), (2) difficulties engaging providers and patients in CKD management (cognitive participation), (3) limited time and competing demands (collective action), and (4) challenges obtaining and using data to monitor progress (reflexive monitoring). Conclusions: Addressing the barriers to implementation with concrete interventions at the levels at which they occur, informed by NPT, will ultimately improve the quality of CKD patient care. |
| Databáze: | OpenAIRE |
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