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

Apr 18, 2019Journal of general internal medicine

Primary Care Doctors’ Views on Challenges in Referring and Working with Kidney Specialists for Chronic Kidney Disease Patients

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Abstract

Of the 32 primary care physicians surveyed, 94% spent at least 80% of their time in clinical care.

Barriers to effective co-management of chronic kidney disease include difficulties in building partnerships with nephrologists.
PCPs reported challenges related to the timely exchange of information, such as not receiving consult notes or having unclear care plans.
Unclear roles and responsibilities between PCPs and nephrologists were frequently noted as a barrier.
Limited access to nephrologists, including difficulties in obtaining consultations and contacting them with concerns, was also identified.
PCPs suggested that better communication tools, like shared electronic medical records, could enhance collaboration with nephrologists.

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

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