St Georges, University of London, London.
Br J Gen Pract. 2010 Jun;60(575):403-9. doi: 10.3399/bjgp10X502100.
Chronic kidney disease (CKD) is associated with increased cardiovascular mortality and morbidity as well as progression to established renal failure. Interventions in primary care, particularly the lowering of blood pressure in individuals with CKD and proteinuria and diabetes, can slow disease progression. This evidence base is codified in national guidance and in a simplified form in pay-for-performance targets. Prior to conducting the QICKD study - a cluster of quality-improvement interventions with reduction of blood pressure as its primary outcome measure - a diagnostic analysis was conducted to assess the relevance of the intended interventions.
To understand practitioners' views of CKD and its management.
Focus groups were held in five locations across England. Experienced facilitators developed a standardised approach and analysed data using the 'framework' approach.
Practitioners varied in their views of CKD and their embracing of the guidance. Some sought to implement the full guidance, others only the pay-for-performance targets. Nearly all practitioners had reservations as to whether CKD was really a disease; problematised the diagnosis of CKD purely on an estimate of glomerular filtration rate; questioned whether CKD in older people was part of natural ageing; and had experienced difficulty in explaining the condition to patients without frightening them. Most reported both problems and scepticism concerning the blood pressure targets, and acknowledged educational gaps.
Practitioners have disparate views about CKD. The quality-improvement interventions in the QICKD study will need to incorporate a large element of education. CKD guidelines may have been introduced without sufficient educational support.
慢性肾脏病（CKD）与心血管死亡率和发病率增加以及进展为既定肾衰竭有关。初级保健中的干预措施，特别是降低 CKD 和蛋白尿及糖尿病患者的血压，可以减缓疾病进展。该证据基础已编入国家指南，并以简化形式编入按效付费目标。在开展 QICKD 研究（以降低血压为主要观察指标的一系列质量改进干预措施）之前，进行了诊断性分析，以评估预期干预措施的相关性。
了解从业者对 CKD 及其管理的看法。
在英格兰五个地点举行了焦点小组会议。经验丰富的主持人采用标准化方法，并使用“框架”方法分析数据。
从业者对 CKD 及其对指南的接受程度存在差异。一些人试图实施全部指南，另一些人仅实施按效付费目标。几乎所有从业者都对 CKD 是否真的是一种疾病持保留意见；仅根据肾小球滤过率的估计值对 CKD 的诊断提出质疑；对老年人的 CKD 是否是自然衰老的一部分提出质疑；并在向患者解释病情而不引起他们恐慌方面遇到困难。大多数人报告了血压目标的问题和怀疑，并且承认存在教育差距。
从业者对 CKD 有不同的看法。QICKD 研究中的质量改进干预措施将需要纳入大量教育内容。CKD 指南的引入可能没有得到足够的教育支持。
