1
|
Vassalotti JA, Boucree SC. Integrating Chronic Kidney Disease (CKD) into U.S. Primary Care: Bridging the knowledge and implementation gaps. Kidney Int Rep 2022; 7:389-396. [PMID: 35257053 PMCID: PMC8897496 DOI: 10.1016/j.ekir.2022.01.1066] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Joseph A. Vassalotti
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- The National Kidney Foundation, Inc., New York, New York, USA
- Correspondence: Joseph A. Vassalotti, Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Nephrology, Box 1243, New York, New York 10029, USA.
| | | |
Collapse
|
2
|
Vassalotti JA. Recent International Progress in Preventive Nephrology and the Road Less Traveled Ahead. Kidney Int Rep 2021; 6:565-567. [PMID: 33732972 PMCID: PMC7938198 DOI: 10.1016/j.ekir.2021.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Joseph A Vassalotti
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,National Kidney Foundation, Inc., New York, New York, USA
| |
Collapse
|
3
|
Vassalotti JA, Thavarajah S. Combined Albuminuria and Estimated GFR Laboratory Reporting Affects Primary Care Management of CKD. Kidney Med 2020; 2:235-238. [PMID: 32734944 PMCID: PMC7380398 DOI: 10.1016/j.xkme.2020.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Joseph A. Vassalotti
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, Inc, New York, NY
- The National Kidney Foundation, Inc, New York, NY
| | - Sumeska Thavarajah
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
4
|
Sperati CJ, Soman S, Agrawal V, Liu Y, Abdel-Kader K, Diamantidis CJ, Estrella MM, Cavanaugh K, Plantinga L, Schell J, Simon J, Vassalotti JA, Choi MJ, Jaar BG, Greer RC. Primary care physicians' perceptions of barriers and facilitators to management of chronic kidney disease: A mixed methods study. PLoS One 2019; 14:e0221325. [PMID: 31437198 PMCID: PMC6705804 DOI: 10.1371/journal.pone.0221325] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/06/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Given the high prevalence of chronic kidney disease (CKD), primary care physicians (PCPs) frequently manage early stage CKD. Nonetheless, there are challenges in providing optimal CKD care in the primary care setting. This study sought to understand PCPs' perceptions of barriers and facilitators to the optimal management of CKD. STUDY DESIGN Mixed methods study. SETTINGS AND PARTICIPANTS Community-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC and San Francisco, CA. METHODOLOGY We used a self-administered questionnaire and conducted 4 focus groups of PCPs (n = 8 PCPs/focus group) in each city to identify key barriers and facilitators to management of patients with CKD in primary care. ANALYTIC APPROACH We conducted descriptive analyses of the survey data. Major themes were identified from audio-recorded interviews that were transcribed and coded by the research team. RESULTS Of 32 participating PCPs, 31 (97%) had been in practice for >10 years, and 29 (91%) practiced in a non-academic setting. PCPs identified multiple barriers to managing CKD in primary care including at the level of the patient (e.g., low awareness of CKD, poor adherence to treatment recommendations), the provider (e.g., staying current with CKD guidelines), and the health care system (e.g., inflexible electronic medical record, limited time and resources). PCPs desired electronic prompts and lab decision support, concise guidelines, and healthcare financing reform to improve CKD care. CONCLUSIONS PCPs face substantial but modifiable barriers in providing care to patients with CKD. Interventions that address these barriers and promote facilitative tools may improve PCPs' effectiveness and capacity to care for patients with CKD.
Collapse
Affiliation(s)
- C. John Sperati
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Sandeep Soman
- Division of Nephrology, Henry Ford Hospital, Detroit, Michigan, United States of America
| | - Varun Agrawal
- Division of Nephrology and Hypertension, University of Vermont College of Medicine, Burlington, Vermont, United States of America
| | - Yang Liu
- Johns Hopkins Medicine International, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America
| | - Khaled Abdel-Kader
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center; Vanderbilt Center for Kidney Disease, Nashville, Tennessee, United States of America
| | - Clarissa J. Diamantidis
- Divisions of General Internal Medicine and Nephrology, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Michelle M. Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco and San Francisco VA Health Care System, San Francisco, California, United States of America
| | - Kerri Cavanaugh
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center; Vanderbilt Center for Kidney Disease, Nashville, Tennessee, United States of America
| | - Laura Plantinga
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Jane Schell
- Section of Palliative Care and Medical Ethics, Division of Renal-Electrolyte, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - James Simon
- Department of Nephrology and Hypertension, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Joseph A. Vassalotti
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- National Kidney Foundation, New York, New York, United States of America
| | - Michael J. Choi
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Bernard G. Jaar
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Nephrology Center of Maryland, Baltimore, Maryland, United States of America
- The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, United States of America
| | - Raquel C. Greer
- The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, United States of America
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | | |
Collapse
|
5
|
Tummalapalli SL, Powe NR, Keyhani S. Trends in Quality of Care for Patients with CKD in the United States. Clin J Am Soc Nephrol 2019; 14:1142-1150. [PMID: 31296503 PMCID: PMC6682807 DOI: 10.2215/cjn.00060119] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/04/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Improving the quality of CKD care has important public health implications to delay disease progression and prevent ESKD. National trends of the quality of CKD care are not well established. Furthermore, it is unknown whether gaps in quality of care are due to lack of physician awareness of CKD status of patients or other factors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a national, serial, cross-sectional study of visits to office-based ambulatory care practices for adults with diagnosed CKD from the years 2006 to 2014. We assessed the following quality indicators: (1) BP measurement, (2) uncontrolled hypertension, (3) uncontrolled diabetes, (4) angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use among patients with hypertension, (5) statin use if age ≥50 years old, and (6) nonsteroidal anti-inflammatory drug use. Using multivariable linear regression and chi-squared analysis, we examined the change in quality performance over time. RESULTS Between 2006 and 2014, there were 7099 unweighted visits for patients with CKD representing 186,961,565 weighted visits. There was no difference in the prevalence of uncontrolled hypertension (>130/80 mm Hg) over time (46% in 2006-2008 versus 48% in 2012-2014; P=0.50). There was a high prevalence of uncontrolled diabetes in 2012-2014 (40% for hemoglobin A1c >7%). The prevalence of ACEi/ARB use decreased from 45% in 2006-2008 to 36% in 2012-2014, which did not reach statistical significance (P=0.07). Statin use in patients with CKD who were 50 years or older was low and remained unchanged from 29% in 2006-2008 to 31% in 2012-2014 (P=0.92). CONCLUSIONS In a nationally representative dataset, we found that patients with CKD had a high prevalence of uncontrolled hypertension and diabetes and a low use of statins that did not improve over time and was not concordant with guidelines.
Collapse
Affiliation(s)
- Sri Lekha Tummalapalli
- Division of Nephrology and
- Department of Medicine, University of California, San Francisco, California
| | - Neil R. Powe
- Department of Medicine, University of California, San Francisco, California
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, California; and
| | - Salomeh Keyhani
- Department of Medicine, University of California, San Francisco, California
- Division of General Internal Medicine, San Francisco Veterans Affairs Hospital, San Francisco, California
| |
Collapse
|