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Primary Care Physicians' Perceived Barriers to Nephrology Referral and Co-management of Patients with CKD: a Qualitative Study.

Publication ,  Journal Article
Greer, RC; Liu, Y; Cavanaugh, K; Diamantidis, CJ; Estrella, MM; Sperati, CJ; Soman, S; Abdel-Kader, K; Agrawal, V; Plantinga, LC; Schell, JO ...
Published in: J Gen Intern Med
July 2019

BACKGROUND: Effective co-management of patients with chronic kidney disease (CKD) between primary care physicians (PCPs) and nephrologists is increasingly recognized as a key strategy to ensure the delivery of efficient and high-quality CKD care. However, the co-management of patients with CKD remains suboptimal. OBJECTIVE: We aimed to identify PCPs' perceptions of key barriers and facilitators to effective co-management of patients with CKD at the PCP-nephrology interface. STUDY DESIGN: Qualitative study SETTING AND PARTICIPANTS: Community-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC; and San Francisco, CA APPROACH: We conducted four focus groups of PCPs. Two members of the research team coded transcribed audio-recorded interviews and identified major themes. KEY RESULTS: Most of the 32 PCPs (59% internists and 41% family physicians) had been in practice for > 10 years (97%), spent ≥ 80% of their time in clinical care (94%), and practiced in private (69%) or multispecialty group practice (16%) settings. PCPs most commonly identified barriers to effective co-management of patients with CKD focused on difficulty developing working partnerships with nephrologists, including (1) lack of timely adequate information exchange (e.g., consult note not received or CKD care plan unclear); (2) unclear roles and responsibilities between PCPs and nephrologists; and (3) limited access to nephrologists (e.g., unable to obtain timely consultations or easily contact nephrologists with concerns). PCPs expressed a desire for "better communication tools" (e.g., shared electronic medical record) and clear CKD care plans to facilitate improved PCP-nephrology collaboration. CONCLUSIONS: Interventions facilitating timely adequate information exchange, clear delineation of roles and responsibilities between PCPs and nephrologists, and greater access to specialist advice may improve the co-management of patients with CKD.

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Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

July 2019

Volume

34

Issue

7

Start / End Page

1228 / 1235

Location

United States

Related Subject Headings

  • Renal Insufficiency, Chronic
  • Referral and Consultation
  • Quality of Health Care
  • Qualitative Research
  • Physicians, Primary Care
  • Nephrology
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine
 

Citation

APA
Chicago
ICMJE
MLA
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Greer, R. C., Liu, Y., Cavanaugh, K., Diamantidis, C. J., Estrella, M. M., Sperati, C. J., … National Kidney Foundation Education Committee, . (2019). Primary Care Physicians' Perceived Barriers to Nephrology Referral and Co-management of Patients with CKD: a Qualitative Study. J Gen Intern Med, 34(7), 1228–1235. https://doi.org/10.1007/s11606-019-04975-y
Greer, Raquel C., Yang Liu, Kerri Cavanaugh, Clarissa Jonas Diamantidis, Michelle M. Estrella, C John Sperati, Sandeep Soman, et al. “Primary Care Physicians' Perceived Barriers to Nephrology Referral and Co-management of Patients with CKD: a Qualitative Study.J Gen Intern Med 34, no. 7 (July 2019): 1228–35. https://doi.org/10.1007/s11606-019-04975-y.
Greer RC, Liu Y, Cavanaugh K, Diamantidis CJ, Estrella MM, Sperati CJ, et al. Primary Care Physicians' Perceived Barriers to Nephrology Referral and Co-management of Patients with CKD: a Qualitative Study. J Gen Intern Med. 2019 Jul;34(7):1228–35.
Greer, Raquel C., et al. “Primary Care Physicians' Perceived Barriers to Nephrology Referral and Co-management of Patients with CKD: a Qualitative Study.J Gen Intern Med, vol. 34, no. 7, July 2019, pp. 1228–35. Pubmed, doi:10.1007/s11606-019-04975-y.
Greer RC, Liu Y, Cavanaugh K, Diamantidis CJ, Estrella MM, Sperati CJ, Soman S, Abdel-Kader K, Agrawal V, Plantinga LC, Schell JO, Simon JF, Vassalotti JA, Jaar BG, Choi MJ, National Kidney Foundation Education Committee. Primary Care Physicians' Perceived Barriers to Nephrology Referral and Co-management of Patients with CKD: a Qualitative Study. J Gen Intern Med. 2019 Jul;34(7):1228–1235.
Journal cover image

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

July 2019

Volume

34

Issue

7

Start / End Page

1228 / 1235

Location

United States

Related Subject Headings

  • Renal Insufficiency, Chronic
  • Referral and Consultation
  • Quality of Health Care
  • Qualitative Research
  • Physicians, Primary Care
  • Nephrology
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine