Chronic Kidney Disease Guideline Implementation in Primary Care: A Qualitative Report from the TRANSLATE CKD Study.
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.
From the Department of Family Medicine, State University of New York at Buffalo (BMV, CHF, LSK); the State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY (TRMY); and the American Academy of Family Physicians National Research Network, Leawood, KS (JS). bvest@buffalo.edu.
Bonnie M
BM
Vest
From the Department of Family Medicine, State University of New York at Buffalo (BMV, CHF, LSK); the State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY (TRMY); and the American Academy of Family Physicians National Research Network, Leawood, KS (JS).
Trevor R M
TR
York
From the Department of Family Medicine, State University of New York at Buffalo (BMV, CHF, LSK); the State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY (TRMY); and the American Academy of Family Physicians National Research Network, Leawood, KS (JS).
Jessica
J
Sand
From the Department of Family Medicine, State University of New York at Buffalo (BMV, CHF, LSK); the State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY (TRMY); and the American Academy of Family Physicians National Research Network, Leawood, KS (JS).
Chester H
CH
Fox
From the Department of Family Medicine, State University of New York at Buffalo (BMV, CHF, LSK); the State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY (TRMY); and the American Academy of Family Physicians National Research Network, Leawood, KS (JS).
Linda S
LS
Kahn
D001291:Attitude of Health Personnel; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D058007:Physicians, Primary Care / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012189:Retrospective Studies; D014481:United States
Chronic Renal Diseases; Normalization Process Theory; Primary Health Care; Qualitative Research