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Primary Care Physicians’ Knowledge and Practice Patterns in the Treatment of Chronic Kidney Disease: An Upstate New York Practice-based Research Network (UNYNET) Study

From the Department of Family Medicine (CHF, AB, LEZ)
Department of Medicine and Nephrology (BM), University at Buffalo, Buffalo, NY
Department of Medicine and Nephrology (WM), Emory University, Atlanta, GA

Correspondence: Corresponding author: Chester H. Fox, MD, University at Buffalo, Department of Family Medicine, 462 Grider Street, Buffalo, NY 14215 (E-mail: cfox{at}buffalo.edu)

Background: There is a steady increase in the prevalence of chronic kidney disease (CKD) in the United States. Primary care physicians (PCPs) can engage in strategies that are proven to be effective in reducing the progression rate of kidney disease. The National Kidney Foundation has released evidence-based guidelines called the Kidney Disease Outcome Quality Improvement Initiative (K/DOQI) that detail these strategies. No information exists regarding adoption of these guidelines in primary care.

Methods: A qualitative study in a practice-based research network (PBRN) was undertaken to explore common PCP practices and knowledge regarding CKD. A typical case sampling strategy was followed. Semi-structured interviews and exit surveys were conducted with 10 PCPs from randomly selected PBRN practices. Three reviewers conducted content analysis using the immersion-crystallization approach.

Results: Five general themes emerged as key findings: (1) lack of awareness of K/DOQI guidelines; (2) Desire for more CKD practice guidance; (3) persistence of traditional, less accurate, diagnostic procedure; (4) variability in the treatment of complications; and (5) uncertainty of timing for referral to a nephrologist.

Conclusion: Facing a growing CKD incidence, PCPs can have an impact on preventing its progression and associated complications with increased familiarity of new guidelines.

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