Departments of Medicine, Johns Hopkins University School of Medicine, 1830 E, Monument Street, Suite 416, Baltimore, MD 21205, USA.
BMC Nephrol. 2013 Oct 24;14:230. doi: 10.1186/1471-2369-14-230.
The National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) developed guidelines to care for patients with chronic kidney disease (CKD). While these are disseminated through the NKF's website and publications, the guidelines' usage remains suboptimal. The KDOQI Educational Committee was formed to identify barriers to guideline implementation, determine provider and patient educational needs and develop tools to improve care of patients with CKD.
An online survey was conducted from May to September 2010 to evaluate renal providers' familiarity, current use of and attitudes toward the guidelines and tools to implement the guidelines.
Most responders reported using the guidelines often and felt that they could be easily implemented into clinical practice; however, approximately one-half identified at least one barrier. Physicians and physician extenders most commonly cited the lack of evidence supporting KDOQI guidelines while allied health professionals most commonly listed patient non-adherence, unrealistic guideline goals and provider time-constraints. Providers thought that the guidelines included too much detail and identified the lack of a quick resource as a barrier to clinical implementation. Most were unaware of the Clinical Action Plans.
Perceived barriers differed between renal clinicians and allied health professionals; educational and implementation tools tailored for different providers are needed.
国家肾脏基金会(NKF)肾脏病结果质量倡议(KDOQI)制定了有关慢性肾脏病(CKD)患者护理的指南。尽管这些指南通过 NKF 的网站和出版物进行了传播,但指南的使用仍不尽如人意。KDOQI 教育委员会的成立旨在确定实施指南的障碍,确定提供者和患者的教育需求,并开发工具以改善 CKD 患者的护理。
2010 年 5 月至 9 月期间进行了一项在线调查,以评估肾脏提供者对指南的熟悉程度、当前使用情况和态度,以及实施指南的工具。
大多数应答者报告经常使用指南,并认为它们可以轻松地纳入临床实践;然而,约有一半人发现了至少一个障碍。医生和医生助理最常提到缺乏支持 KDOQI 指南的证据,而联合健康专业人员最常列出患者不遵守、不切实际的指南目标和提供者时间限制。提供者认为指南过于详细,并认为缺乏快速资源是临床实施的障碍。大多数人不知道临床行动计划。
肾脏临床医生和联合健康专业人员之间存在不同的感知障碍;需要为不同的提供者量身定制教育和实施工具。