Primary Care Physicians Report Barriers to Managing Chronic Kidney Disease

September 12, 2019

Lack of knowledge, keeping up with changing management guidelines, and limited time and resources were among reported barriers. 

In a new study, 45% of primary care physicians (PCPs) reported that they do not follow chronic kidney disease (CKD) management guidelines. And, while a majority (94%) are comfortable making a CKD diagnosis, they are not comfortable following the patient.

The new mixed-methods study published in PLoS One found that PCPs face numerous patient-, physician-, and systems-level barriers when managing CKD patients.

“This study builds on the existing evidence to provide detailed views of the challenges US PCPs experience in caring for patients with CKD,” wrote researchers led by Christopher John Sperati, MD, MHS, associate professor of medicine at the Johns Hopkins University School of Medicine and director of the university’s Nephrology Fellowship Training Program. “The findings from this study provide valuable insights that can be used to improve delivery of CKD care in primary care settings.”

CKD is a complex condition associated with an increased risk of comorbidity and progression to end-stage renal disease (ESRD). In the last 20 years there has been an 82% rise in deaths worldwide due to kidney disease.

For this reason, the Department of Health and Human Services (HHS) recently announced its goal of reducing the number of Americans who develop ESRD by 25% by 2030.

The findings from this study, however, show that PCPs face notable barriers to meeting the HHS goal.

To determine PCP’s knowledge of CKD and the key obstacles they face in treating patients, Sperati and colleagues divided 32 PCPs in the US into 4 focus groups based on US geography.

The majority of participants were in practice for >15 years (72%), male (59%), and white (66%); mean age was 53 years and 69% saw >10 CKD patients/week.

A brief, self-administered questionnaire asked participants about their own demographics; medical practice characteristics; comfort level with managing and educating CKD patients; and access to clinical management tools.

After completing the questionnaire, PCPs began the 90-minute focus group to pinpoint the perceived challenges to optimal CKD care and to identify practice aids.

Participants identified various barriers at the patient level (eg, low awareness of CKD, poor adherence to treatment recommendations); provider level (eg, lack of CKD knowledge, poor awareness of guidelines, managing multiple comorbidities); and health care system level (eg, limited time and resources available, inflexible electronic medical record). (Please see infographic below for details)

Although 84% of PCPs said they were comfortable managing patients with CKD, many also claimed they were not comfortable managing specific complications of CKD including anemia (66%), bone disorders (50%), and metabolic acidosis (62%).

A majority of PCPs reported feeling comfortable with the diagnosis of CKD (94%), but also stated that they have issues with the required follow-up steps.

Researchers noted that a belief held by PCPs that CKD is incurable may reinforce these barriers.

“’You can’t fix it. All you can do is [ensure] . . . it doesn’t worsen. We’re not helping . . . it’s not very exciting,’” stated one PCP.

The researchers concluded that, “interventions and health care delivery innovations that enhance PCPs’ CKD knowledge, facilitate PCPs’ provision of guideline concordant care, and/or integrate multidisciplinary teams may improve PCPs’ capacity to effectively care for patients with CKD.”

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