Nash Danielle M, Garg Amit X, Brimble K Scott, Markle-Reid Maureen
ICES, London, Ontario, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
BMC Fam Pract. 2018 Dec 10;19(1):192. doi: 10.1186/s12875-018-0879-2.
Patients should receive follow-up serum creatinine tests after an initial abnormal result to diagnose chronic kidney disease. However, half of the time this fails to occur in primary care. We interviewed primary care providers to better understand their perceptions of enablers and barriers to following this guideline-recommended care.
We performed a qualitative descriptive study guided by the Theoretical Domains Framework (TDF), a framework for behavioural change. We used purposeful sampling to recruit primary care providers (physicians and nurse practitioners) based on provider and practice characteristics (rural, solo versus team practice, etc.) from Ontario, Canada. We completed one-on-one interviews with providers using a semi-structured and open-ended interview guide based on the 14 TDF domains. We alternated between data collection and analysis, where we used directed content analysis to identify frequent, important, and conflicting enablers and barriers.
We completed 13 interviews with nine primary care physicians and four nurse practitioners. Nine themes related to the TDF emerged from the data: 1) environmental context and resources, 2) knowledge, 3) memory, attention, and decision processes, 4) beliefs about consequences, 5) goals, 6) social or professional role, 7) behavioural regulation, 8) skills, and 9) optimism. Within these themes, we identified 16 enablers and five barriers. Some enablers included, providers' knowledge on appropriate testing, their motivation to order these tests, and their use of tools and resources to help order follow-up serum creatinine tests. However, providers perceived some barriers including that ordering confirmatory laboratory tests for chronic kidney disease was not always a priority in regards to other care they wish to provide. Providers also noted that a perceived barrier is patients not going to the laboratory to complete the test.
We identified novel enablers and barriers to primary care providers completing guideline recommended repeat testing for the diagnosis of chronic kidney disease. Similar research is needed to understand the views of patients. These research findings can be used to inform strategies to improve the quality of care.
患者初次血清肌酐检测结果异常后，应接受后续检测以诊断慢性肾脏病。然而，在初级医疗中，这种情况有一半的时间未能发生。我们对初级医疗服务提供者进行了访谈，以更好地了解他们对遵循该指南推荐护理的促进因素和障碍的看法。
我们进行了一项以行为改变框架理论领域框架（TDF）为指导的定性描述性研究。我们基于提供者和实践特征（农村、单人执业与团队执业等），从加拿大安大略省采用目的抽样法招募初级医疗服务提供者（医生和执业护士）。我们使用基于14个TDF领域的半结构化开放式访谈指南对提供者进行一对一访谈。我们在数据收集和分析之间交替进行，使用定向内容分析来识别频繁、重要和相互冲突的促进因素和障碍。
我们完成了对9名初级医疗医生和4名执业护士的13次访谈。数据中出现了与TDF相关的9个主题：1）环境背景和资源，2）知识，3）记忆、注意力和决策过程，4）对后果的信念，5）目标，6）社会或职业角色，7）行为调节，8）技能，9）乐观主义。在这些主题中，我们识别出16个促进因素和5个障碍。一些促进因素包括，提供者对适当检测的知识、开具这些检测的动机以及他们使用工具和资源来帮助开具后续血清肌酐检测的情况。然而，提供者认为存在一些障碍，包括就他们希望提供的其他护理而言，为慢性肾脏病开具确认性实验室检测并不总是优先事项。提供者还指出，一个明显的障碍是患者不去实验室完成检测。
我们识别出了初级医疗服务提供者完成指南推荐的慢性肾脏病诊断重复检测的新的促进因素和障碍。需要进行类似研究以了解患者的观点。这些研究结果可用于为提高护理质量的策略提供信息。
