Smekal Michelle D, Tam-Tham Helen, Finlay Juli, Donald Maoliosa, Benterud Eleanor, Thomas Chandra, Quinn Robert R, Tam Kin, Manns Braden J, Tonelli Marcello, Bello Aminu, Tangri Navdeep, Hemmelgarn Brenda R
Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.
Can J Kidney Health Dis. 2018 Mar 23;5:2054358118763809. doi: 10.1177/2054358118763809. eCollection 2018.
The kidney failure risk equation (KFRE) provides an estimate of risk of progression to kidney failure, and may guide clinical care.
We aimed to describe patient, family, and health care provider's perspectives of the perceived benefits and challenges of using a risk-based approach to guide care delivery for patients with advanced chronic kidney disease (CKD), and refine implementation based on their input.
We used qualitative methodology to explore perceived benefits and challenges of implementing a risk-based approach (using the KFRE) to determine eligibility for multidisciplinary CKD care in Southern Alberta. We obtained perspectives from patients and families through focus groups, as well as input from health care providers through interviews and open-ended responses from an online survey. Twelve patients/family members participated in 2 focus groups, 16 health care providers participated in an interview, and 40 health care providers responded to the survey.
Overall, participants felt that a KFRE-based approach had the potential to improve efficiency of the clinics by targeting care to patients at highest risk of kidney failure; however, they also expressed concerns about the impact of loss of services for lower risk individuals. Participants also articulated concerns about a perceived lack of capacity for adequate CKD patient care in the community. Our implementation strategy was modified as a result of participants' feedback.
We identified benefits and challenges to implementation of a risk-based approach to guide care of patients with advanced CKD. Based on these results, our implementation strategy has been modified by removing the category of referral back to primary care alone, and instead having that decision made jointly by nephrologists and patients among low-risk patients.
肾衰竭风险方程（KFRE）可估算进展至肾衰竭的风险，并可能指导临床护理。
我们旨在描述患者、家属及医疗服务提供者对于采用基于风险的方法指导晚期慢性肾脏病（CKD）患者护理的感知益处和挑战，并根据他们的意见完善实施策略。
我们采用定性研究方法，探讨在艾伯塔省南部实施基于风险的方法（使用KFRE）以确定多学科CKD护理资格的感知益处和挑战。我们通过焦点小组收集患者和家属的意见，以及通过访谈和在线调查中的开放式回答收集医疗服务提供者的意见。12名患者/家属参与了2个焦点小组，16名医疗服务提供者参与了访谈，40名医疗服务提供者回复了调查。
总体而言，参与者认为基于KFRE的方法有潜力通过将护理目标对准肾衰竭风险最高的患者来提高诊所效率；然而，他们也对低风险个体服务减少的影响表示担忧。参与者还表达了对社区中CKD患者护理能力不足的担忧。根据参与者的反馈，我们修改了实施策略。
我们确定了采用基于风险的方法指导晚期CKD患者护理的益处和挑战。基于这些结果，我们修改了实施策略，取消了仅转回初级护理的转诊类别，而是由肾病学家和低风险患者共同做出该决定。
