RESUMO
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.
Assuntos
Atitude do Pessoal de Saúde , Gerenciamento Clínico , Médicos de Atenção Primária/normas , Atenção Primária à Saúde/organização & administração , Pesquisa Qualitativa , Insuficiência Renal Crônica/terapia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Estados UnidosRESUMO
OBJECTIVE: This study explored the self-management strategies and treatment burden experienced by low-income US primary care patients with chronic kidney disease. METHODS: Semi-structured interviews were conducted with 34 patients from two primary care practices on Buffalo's East Side, a low-income community. Qualitative analysis was undertaken using an inductive thematic content analysis approach. We applied normalization process theory (NPT) to the concept of treatment burden to interpret and categorize our findings. RESULTS: The sample was predominantly African-American (79%) and female (59%). Most patients (79%) had a diagnosis of stage 3 CKD. Four major themes were identified corresponding to NPT and treatment burden: (1) coherence--making sense of CKD; (2) cognitive participation--enlisting support and organizing personal resources; (3) collective action--self-management work; and (4) reflexive monitoring--further refining chronic illness self-care in the context of CKD. For each component, we identified barriers hindering patients' ability to accomplish the necessary tasks. CONCLUSIONS: Our findings highlight the substantial treatment burden faced by inner-city primary care patients self-managing CKD in combination with other chronic illnesses. Health care providers' awareness of treatment burden can inform the development of person-centered care plans that can help patients to better manage their chronic illnesses.