title: Understanding the management of early-stage chronic kidney disease in primary care: a qualitative study.
abstract: BACKGROUND
  Primary care is recognised to have an important role in the delivery of care for people with chronic kidney disease (CKD). However, there is evidence that CKD management is currently suboptimal, with a range of practitioner concerns about its management.
  
  
  OBJECTIVE
  To explore processes underpinning the implementation of CKD management in primary care.
  
  
  METHODS
  Qualitative study in general practices participating in a chronic kidney disease collaborative undertaken as part of the National Institute for Health  Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester.
  
  
  METHODS
  Semi-structured interviews were conducted with GPs and practice nurses (n = 21). Normalisation Process Theory provided a framework for generation  and analysis of the data.
  
  
  RESULTS
  A predominant theme was anxiety about the disclosure of early-stage CKD with patients. The tensions experienced related to identifying and discussing CKD in older people and patients with stage 3A, embedding early-stage CKD within vascular  care, and the distribution of work within the practice team. Participants provided accounts of work undertaken to resolve the difficulties encountered, with efforts having tended to focus on reassuring patients. Analysis also highlighted how anxiety surrounding disclosure influenced, and was  shaped by, the organisation of care for people with CKD and associated long-term conditions.
  
  
  CONCLUSIONS
  Offering reassurance alone may be of limited benefit, and current management of early-stage CKD in primary care may miss opportunities to address susceptibility to kidney  injury, improve self-management of vascular conditions, and improve the management of multimorbidity.
authors.affiliation: Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester. tom.blakeman@manchester.ac.uk
authors.forename: Tom
authors.initials: T
authors.lastname: Blakeman
authors.forename: Joanne
authors.initials: J
authors.lastname: Protheroe
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chew-Graham
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
mesh_terms: D000328:Adult; D001007:Anxiety / Q000517:prevention & control; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care; D030881:Disclosure; D004739:England; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D011364:Professional Practice; D051436:Renal Insufficiency, Chronic / Q000523:psychology / Q000628:therapy*