title: Clinician's use of automated reports of estimated glomerular filtration rate: a qualitative study.
abstract: BACKGROUND
  There is a growing awareness in primary care of the importance of identifying patients with chronic kidney disease (CKD) so that they can receive appropriate clinical care; one method that has been widely embraced is the use of automated reporting of estimated glomerular filtration rate (eGFR) by clinical laboratories. We undertook a qualitative study to examine how clinicians use eGFR in clinical decision making, patient communication issues, barriers to use of eGFR, and suggestions to improve the clinical usefulness of eGFR reports.
  
  
  METHODS
  Our study used qualitative methods with structured interviews among primary care clinicians including both physicians and allied health providers, recruited from Kaiser Permanente Northwest, a non-profit health maintenance organization.
  
  
  RESULTS
  We found that clinicians generally held favorable views toward eGFR reporting but did not use eGFR to replace serum creatinine in their clinical decision-making. Clinicians used eGFR as a tool to help identify CKD, educate patients about their kidney function and make treatment decisions. Barriers noted by several clinicians included a desire for greater education regarding care for patients with CKD and tools to facilitate discussion of eGFR findings with patients.
  
  
  CONCLUSIONS
  The manner in which clinicians use eGFRs appears to be more complex than previously understood, and our study illustrates some of the efforts that might be usefully undertaken (e.g. specific clinician education) when encouraging further promulgation of eGFR reporting and usage.
authors.affiliation: The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA. David.h.smith@kpchr.org
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schneider
authors.forename: Micah L
authors.initials: ML
authors.lastname: Thorp
authors.forename: Suma
authors.initials: S
authors.lastname: Vupputuri
authors.forename: Jessica W
authors.initials: JW
authors.lastname: Weiss
authors.forename: Eric S
authors.initials: ES
authors.lastname: Johnson
authors.forename: Adrianne
authors.initials: A
authors.lastname: Feldstein
authors.forename: Amanda F
authors.initials: AF
authors.lastname: Petrik
authors.forename: Xuihai
authors.initials: X
authors.lastname: Yang
authors.forename: Susan R
authors.initials: SR
authors.lastname: Snyder
mesh_terms: D003657:Decision Making; D057286:Electronic Health Records / Q000592:standards*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D058007:Physicians, Primary Care / Q000592:standards*; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D036301:Qualitative Research; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000503:physiopathology; D058028:Research Report / Q000592:standards*