title: Development and implementation of an online clinical pathway for adult chronic kidney disease in primary care: a mixed methods study.
abstract: Primary care physicians and other primary health care professionals from Alberta, Canada identified a clinical pathway as a potential tool to facilitate uptake of clinical practice guidelines for the diagnosis, management and referral of adults with chronic kidney disease. We describe the development and implementation of a chronic kidney disease clinical pathway (CKD-CP; www.ckdpathway.ca ).
  
  
  
  The CKD-CP was developed and implemented based on the principles of the Knowledge-To-Action Cycle framework. We used a mixed methods approach to identify the usability and feasibility of the CKD-CP. This included individual interviews, an online survey and website analytics, to gather data on barriers and facilitators to use, perceived usefulness and characteristics of users. Results are reported using conventional qualitative content analysis and descriptive statistics.
  
  
  
  Eighteen individual interviews were conducted with primary care physicians, nephrologists, pharmacists and nurse practitioners to identify themes reflecting both barriers and facilitators to integrating the CKD-CP into clinical practice. Themes identified included: communication, work efficiency and confidence. Of the 159 participants that completed the online survey, the majority (52 %) were first time CKD-CP users. Among those who had previously used the CKD-CP, 94 % agreed or strongly agreed that the pathway was user friendly, provided useful information and increased their knowledge and confidence in the care of patients with CKD. Between November 2014 and July 2015, the CKD-CP website had 10,710 visits, 67 % of which were new visitors. The 3 most frequently visited web pages were home, diagnose and medical management. Canada, Indonesia and the United States were the top 3 countries accessing the website during the 9 month period.
  
  
  
  An interactive, online, point-of-care tool for primary care providers can be developed and implemented to assist in the care of patients with CKD. Our findings are important for making refinements to the CKD -CP website via ongoing discussions with end-users and the development team, along with continued dissemination using multiple strategies.
authors.affiliation: Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.|Interdisciplinary Chronic Disease Collaboration, Teaching Research and Wellness Building, GE 59, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
authors.forename: Maoliosa
authors.initials: M
authors.lastname: Donald
authors.affiliation: Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.|Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.|Interdisciplinary Chronic Disease Collaboration, Teaching Research and Wellness Building, GE 59, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.|O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
authors.forename: Kerry
authors.initials: K
authors.lastname: McBrien
authors.affiliation: Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
authors.forename: Wes
authors.initials: W
authors.lastname: Jackson
authors.affiliation: Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.|Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.|Interdisciplinary Chronic Disease Collaboration, Teaching Research and Wellness Building, GE 59, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.|O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
authors.affiliation: Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.|Interdisciplinary Chronic Disease Collaboration, Teaching Research and Wellness Building, GE 59, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.affiliation: Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.|Faculty of Nursing, University of Calgary, 2800 University Way NW, Calgary, AB, T2N 1N4, Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: King-Shier
authors.affiliation: Department of Medicine, University of Alberta, 8440 112 Street, Edmonton, AB, T6G 2G3, Canada.
authors.forename: Kailash
authors.initials: K
authors.lastname: Jindal
authors.affiliation: Department of Medicine, University of Alberta, 8440 112 Street, Edmonton, AB, T6G 2G3, Canada.
authors.forename: Richard Z
authors.initials: RZ
authors.lastname: Lewanczuk
authors.affiliation: Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
authors.forename: Nairne
authors.initials: N
authors.lastname: Scott-Douglas
authors.affiliation: Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
authors.forename: Ted
authors.initials: T
authors.lastname: Braun
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.|Department of Medicine, University of Toronto, Suite RFE 3-805, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Straus
authors.affiliation: Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Naugler
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada.
authors.forename: Meghan J
authors.initials: MJ
authors.lastname: Elliott
authors.affiliation: Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
authors.forename: Min
authors.initials: M
authors.lastname: Jun
authors.affiliation: Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada. Brenda.Hemmelgarn@ahs.ca.|Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada. Brenda.Hemmelgarn@ahs.ca.|Interdisciplinary Chronic Disease Collaboration, Teaching Research and Wellness Building, GE 59, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada. Brenda.Hemmelgarn@ahs.ca.|Cumming School of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada. Brenda.Hemmelgarn@ahs.ca.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
mesh_terms: D000328:Adult; D019091:Critical Pathways; D006801:Humans; D020407:Internet; D008491:Medical Informatics Applications; D019095:Point-of-Care Systems; D011320:Primary Health Care / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000628:therapy*
keywords: Chronic Kidney Disease; Clinical pathway; Knowledge-To-Action Cycle; Online; Point-of-care tool; Primary care