Journal
BRITISH JOURNAL OF GENERAL PRACTICE
Volume 60, Issue 575, Pages 403-409Publisher
ROYAL COLL GENERAL PRACTITIONERS
DOI: 10.3399/bjgp10X502100
Keywords
chronic disease; medication therapy management; patient-physician relations
Categories
Funding
- Health Foundation (UK) [7395/4843]
- University Hospitals of Leicester, Kidney Research UK
- St George's - University of London
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Background Chronic kidney disease (CKD) is associated with increased cardiovascular mortality and morbidity as well as progression to established renal failure. Interventions in primary care, particularly the lowering of blood pressure in individuals with CKD and proteinuria and diabetes, can slow disease progression. This evidence base is codified in national guidance and in a simplified form in pay-for-.performance targets. Prior to conducting the QICKD study - a cluster of quality-improvement interventions with reduction of blood pressure as its primary outcome measure - a diagnostic analysis was conducted to assess the relevance of the intended interventions. Aim To understand practitioners' views of CKD and its management. Method Focus groups were held in five locations across England. Experienced facilitators developed a standardised approach and analysed data using the 'framework' approach. Results Practitioners varied in their views of CKD and their embracing of the guidance. Some sought to implement the full guidance, others only the pay-for-performance targets. Nearly all practitioners had reservations as to. whether CKD was really a disease; problematised the diagnosis of CKD purely on an estimate of glomerular filtration rate; questioned whether CKD in older people was part of natural ageing; and had experienced difficulty in explaining the condition to patients without frightening them. Most reported both problems and scepticism concerning the blood pressure targets, and acknowledged educational gaps. Conclusion Practitioners have disparate views about CKD. The quality-improvement interventions in the QICKD study will need to incorporate a large element of education. CKD guidelines may have been introduced without sufficient educational support.
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