初级保健中慢性肾脏病指南的实施：来自“翻译慢性肾脏病研究”的定性报告
Chronic Kidney Disease Guideline Implementation in Primary Care: A Qualitative Report from the TRANSLATE CKD Study.
作者信息
Vest Bonnie M, York Trevor R M, Sand Jessica, Fox Chester H, Kahn Linda S
机构信息
From the Department of Family Medicine, State University of New York at Buffalo (BMV, CHF, LSK); the State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY (TRMY); and the American Academy of Family Physicians National Research Network, Leawood, KS (JS).
出版信息
J Am Board Fam Med. 2015 Sep-Oct;28(5):624-31. doi: 10.3122/jabfm.2015.05.150070.
BACKGROUND
Primary care physicians (PCPs) are optimally situated to identify and manage early stage chronic kidney disease (CKD). Nonetheless, studies have documented suboptimal PCP understanding, awareness, and management of early CKD. The TRANSLATE CKD study is an ongoing national, mixed-methods, cluster randomized control trial that examines the implementation of evidence-based guidelines for CKD into primary care practice.
METHODS
As part of the mixed-methods process evaluation, semistructured interviews were conducted by phone with 27 providers participating in the study. Interviews were audio-taped and transcribed. Thematic content analysis was used to identify themes. Themes were categorized according to the 4 domains of Normalization Process Theory (NPT).
RESULTS
Identified themes illuminated the complex work undertaken to manage CKD in primary care practices. Barriers to guideline implementation were identified in each of the 4 NPT domains, including (1) lack of knowledge and understanding around CKD (coherence), (2) difficulties engaging providers and patients in CKD management (cognitive participation), (3) limited time and competing demands (collective action), and (4) challenges obtaining and using data to monitor progress (reflexive monitoring).
CONCLUSIONS
Addressing the barriers to implementation with concrete interventions at the levels at which they occur, informed by NPT, will ultimately improve the quality of CKD patient care.
背景
基层医疗医生（PCP）处于识别和管理早期慢性肾脏病（CKD）的最佳位置。尽管如此，研究表明基层医疗医生对早期CKD的理解、认识和管理并不理想。“翻译CKD研究”是一项正在进行的全国性、混合方法、整群随机对照试验，该试验考察了将CKD循证指南应用于基层医疗实践的情况。
方法
作为混合方法过程评估的一部分，通过电话对参与研究的27名医疗服务提供者进行了半结构化访谈。访谈进行了录音和转录。采用主题内容分析法来确定主题。主题根据规范化过程理论（NPT）的4个领域进行分类。
结果
确定的主题揭示了在基层医疗实践中管理CKD所开展的复杂工作。在NPT的4个领域中均发现了指南实施的障碍，包括：（1）对CKD缺乏知识和理解（连贯性）；（2）让医疗服务提供者和患者参与CKD管理存在困难（认知参与）；（3）时间有限且需求相互竞争（集体行动）；（4）在获取和使用数据以监测进展方面存在挑战（反思性监测）。
结论
根据NPT，在障碍出现的层面采取具体干预措施来解决实施障碍，最终将提高CKD患者的护理质量。
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