Fox Chester H, Brooks Amanda, Zayas Luis E, McClellan William, Murray Brian
Department of Family Medicine, University at Buffalo, 462 Grider Street, Buffalo, NY 14215, USA.
J Am Board Fam Med. 2006 Jan-Feb;19(1):54-61. doi: 10.3122/jabfm.19.1.54.
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.
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.
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.
Facing a growing CKD incidence, PCPs can have an impact on preventing its progression and associated complications with increased familiarity of new guidelines.
美国慢性肾脏病（CKD）的患病率在稳步上升。初级保健医生（PCP）可以采用经证实有效的策略来降低肾病的进展速度。美国国家肾脏基金会发布了名为《肾脏病预后质量倡议》（K/DOQI）的循证指南，详细阐述了这些策略。目前尚无关于这些指南在初级保健中采用情况的信息。
在一个基于实践的研究网络（PBRN）中开展了一项定性研究，以探索PCP关于CKD的常见做法和知识。采用典型案例抽样策略。对从随机选择的PBRN诊所中选取的10名PCP进行了半结构化访谈和离职调查。三名评审员采用沉浸 - 结晶法进行了内容分析。
出现了五个主要主题作为关键发现：（1）对K/DOQI指南缺乏认识；（2）希望获得更多CKD实践指导；（3）传统的、准确性较低的诊断程序持续存在；（4）并发症治疗的变异性；（5）转诊至肾病专家的时机不确定性。
面对不断上升的CKD发病率，PCP通过增加对新指南的熟悉程度，可以对预防其进展及相关并发症产生影响。
