title: A scoping review of adult chronic kidney disease clinical pathways for primary care.
abstract: BACKGROUND
  Chronic kidney disease (CKD) affects ∼10% of the adult population. The majority of patients with CKD are managed by primary care physicians, and despite the availability of effective treatment options, the use of evidence-based interventions for CKD in this setting remains suboptimal. Clinical pathways have been identified as effective tools to guide primary care physicians in providing evidence-based care. We aimed to describe the availability, characteristics and credibility of clinical pathways for adult CKD using a scoping review methodology.
  
  
  METHODS
  We searched Medline, Embase, CINAHL and targeted Internet sites from inception to 31 October 2014 to identify studies and resources that identified adult CKD clinical pathways for primary care settings. Study selection and data extraction were independently performed by two reviewers.
  
  
  RESULTS
  From 487 citations, 41 items were eligible for review: 7 published articles and 34 grey literature resources published between 2001 and 2014. Of the 41 clinical pathways, 32, 24 and 22% were from the UK, USA and Canada, respectively. The majority (66%, n = 31) of clinical pathways were static in nature (did not have an online interactive feature). The majority (76%) of articles/resources reported using one or more clinical practice guidelines as a resource to guide the clinical pathway content. Few articles described a dissemination and evaluation plan for the clinical pathway, but most reported the targeted end-users.
  
  
  CONCLUSIONS
  Our scoping review synthesized available literature on CKD clinical pathways in the primary care setting. We found that existing clinical pathways are diverse in their design, content and implementation. These results can be used by researchers developing or testing new or existing clinical pathways and by practitioners and health system stakeholders who aim to implement CKD clinical pathways in clinical practice.
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Meghan J
authors.initials: MJ
authors.lastname: Elliott
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB, Canada T2N 4N1.|Interdisciplinary Chronic Disease Collaboration, Calgary, AB, Canada T2N 4Z6.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gil
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB, Canada T2N 4N1.|Interdisciplinary Chronic Disease Collaboration, Calgary, AB, Canada T2N 4Z6.|Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB, Canada T2N 4N1.|Interdisciplinary Chronic Disease Collaboration, Calgary, AB, Canada T2N 4Z6.|Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB, Canada T2N 4N1.|Interdisciplinary Chronic Disease Collaboration, Calgary, AB, Canada T2N 4Z6.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB, Canada T2N 4N1.
authors.forename: Min
authors.initials: M
authors.lastname: Jun
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB, Canada T2N 4N1.|Interdisciplinary Chronic Disease Collaboration, Calgary, AB, Canada T2N 4Z6.
authors.forename: Maoliosa
authors.initials: M
authors.lastname: Donald
mesh_terms: D000328:Adult; D019091:Critical Pathways; D006801:Humans; D011320:Primary Health Care; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome
keywords: chronic kidney disease (CKD); clinical pathways; guideline-concordant care; primary care; scoping review