title: Development of a questionnaire to evaluate practitioners' confidence and knowledge in primary care in managing chronic kidney disease.
abstract: BACKGROUND
  In the UK, chronic disease, including chronic kidney disease (CKD) is largely managed in primary care. We developed a tool to assess practitioner confidence and knowledge in managing CKD compared to other chronic diseases. This questionnaire was part of a cluster randomised quality improvement interventions in chronic kidney disease (QICKD; ISRCTN56023731).
  
  
  METHODS
  The questionnaire was developed by family physicians, primary care nurses, academics and renal specialists. We conducted three focus groups (n=7, 6, and 8) to refine the questionnaire using groups of general practitioners, practice nurses and trainees in general practice. We used paper based versions to develop the questionnaire and online surveys to test it. Practitioners in a group of volunteer, trial practices received the questionnaire twice. We measured its reliability using Cohen's Kappa (K).
  
  
  RESULTS
  The practitioners in the focus groups reached a consensus as to the key elements to include in the instrument. We achieved a 73.1% (n=57/78) initial response rate for our questionnaire; of these 57, 54 completed the questionnaire a second time. Family physicians made up the largest single group of respondents (47.4%, n=27). Initial response showed more female (64.9%, n=37) than male (35.1%, n=20) respondents. The reliability results from retesting showed that there was moderate agreement (k>0.4) on all questions; with many showing substantial agreement (k>0.6). There was substantial agreement in the questions about loop diuretics (k=0.608, CI 0.432-0.784, p<0.001), confidence in managing hypertension (k=0.628, 95%CI 0.452-0.804, p<0.001), diastolic blood pressure treatment thresholds in CKD (k=0.608, 95%CI 0.436-0.780, p<0.001) and the rate of decline of eGFR that would prompt referral (k=0.764, 95%CI 0.603-0.925, p<0.001).
  
  
  CONCLUSIONS
  The QICKD-CCQ is a reliable instrument for measuring confidence and knowledge among primary care practitioners on CKD management in the context of UK primary care.
authors.affiliation: Department of Health Care Management and Policy, School of Management, University of Surrey, Guildford, Surrey GU2 7XH, UK. mtahir@nhs.net.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Tahir
authors.forename: Simon
authors.initials: S
authors.lastname: Hassan
authors.forename: Simon
authors.initials: S
authors.lastname: de Lusignan
authors.forename: Lazza
authors.initials: L
authors.lastname: Shaheen
authors.forename: Tom
authors.initials: T
authors.lastname: Chan
authors.forename: Olga
authors.initials: O
authors.lastname: Dmitrieva
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D004650:Employee Performance Appraisal / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000145:classification / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000628:therapy*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D006113:United Kingdom