Why do family physicians fail to detect renal impairment?
OBJECTIVE
To investigate why many patients with renal impairment (30.7%) were not recognized by their family physicians despite an earlier educational intervention on detecting renal impairment; and to determine whether certain factors related to physicians, patients, or the intervention itself were associated with whether renal impairment was detected.


METHODS
Qualitative approach using grounded theory.


METHODS
A Health Service Organization in Ottawa, Ont.


METHODS
A purposeful sample of six family physicians.


METHODS
In semistructured interviews, participants were asked to describe the workup ordered and their decision-making processes for patients in whom they had recently detected renal impairment. They were also asked to evaluate the six components of an educational intervention designed to help them to detect renal impairment. Finally, one patient's chart was reviewed (a chart containing a laboratory report noting an abnormal result for kidney function and having no indication that renal impairment had been recognized) to identify reasons for lack of detection.


RESULTS
Most physicians did not investigate every patient with renal impairment (glomerular filtration rate of < 78 mL/min) in the same way because they took individual patient factors into consideration. Reasons for not detecting renal impairment were "managed differently" or "missed," with the former being the most common. The educational intervention physicians remembered most often was chart rounds, and these were viewed as helpful. "Missed" cases were more often deliberately managed differently than unintentionally not detected.


CONCLUSIONS
Physicians used various approaches to detect and manage renal impairment despite interventions that recommended a consistent procedure.
Hogg
William
W
Department of Family Medicine, University of Ottawa, Ont.
Rowan
Margo S
MS
Lemelin
Jacques
J
Swedko
Peter J
PJ
Magner
Peter O
PO
Clark
Heather D
HD
Akbari
Ayub
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D003951:Diagnostic Errors; D004502:Education, Medical, Continuing; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008487:Medical History Taking; D009864:Ontario; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D051437:Renal Insufficiency / Q000175:diagnosis*