基层医疗机构医生对慢性肾脏病患者转肾科就诊和共同管理的认知障碍：一项定性研究。
Primary Care Physicians' Perceived Barriers to Nephrology Referral and Co-management of Patients with CKD: a Qualitative Study.
机构信息
The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA.
Division of General Internal Medicine, Johns Hopkins University, 2024 E. Monument Street, Suite 2-600, Baltimore, MD, 21287, USA.
出版信息
J Gen Intern Med. 2019 Jul;34(7):1228-1235. doi: 10.1007/s11606-019-04975-y. Epub 2019 Apr 16.
BACKGROUND
Effective co-management of patients with chronic kidney disease (CKD) between primary care physicians (PCPs) and nephrologists is increasingly recognized as a key strategy to ensure the delivery of efficient and high-quality CKD care. However, the co-management of patients with CKD remains suboptimal.
OBJECTIVE
We aimed to identify PCPs' perceptions of key barriers and facilitators to effective co-management of patients with CKD at the PCP-nephrology interface.
STUDY DESIGN
Qualitative study SETTING AND PARTICIPANTS: Community-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC; and San Francisco, CA APPROACH: We conducted four focus groups of PCPs. Two members of the research team coded transcribed audio-recorded interviews and identified major themes.
KEY RESULTS
Most of the 32 PCPs (59% internists and 41% family physicians) had been in practice for > 10 years (97%), spent ≥ 80% of their time in clinical care (94%), and practiced in private (69%) or multispecialty group practice (16%) settings. PCPs most commonly identified barriers to effective co-management of patients with CKD focused on difficulty developing working partnerships with nephrologists, including (1) lack of timely adequate information exchange (e.g., consult note not received or CKD care plan unclear); (2) unclear roles and responsibilities between PCPs and nephrologists; and (3) limited access to nephrologists (e.g., unable to obtain timely consultations or easily contact nephrologists with concerns). PCPs expressed a desire for "better communication tools" (e.g., shared electronic medical record) and clear CKD care plans to facilitate improved PCP-nephrology collaboration.
CONCLUSIONS
Interventions facilitating timely adequate information exchange, clear delineation of roles and responsibilities between PCPs and nephrologists, and greater access to specialist advice may improve the co-management of patients with CKD.
背景
人们越来越认识到，初级保健医生（PCP）与肾病医生之间有效共同管理慢性肾脏病（CKD）患者是确保提供高效、高质量 CKD 护理的关键策略。然而，CKD 患者的共同管理仍不尽如人意。
目的
我们旨在确定 PCP 对 PCP-肾病学界面有效管理 CKD 患者的主要障碍和促进因素的看法。
研究设计
定性研究
地点和参与者
美国四个城市的社区 PCP：马里兰州巴尔的摩；密苏里州圣路易斯；北卡罗来纳州罗利；和加利福尼亚州旧金山
方法
我们进行了四组 PCP 焦点小组。研究团队的两名成员对转录的音频记录采访进行了编码，并确定了主要主题。
主要结果
大多数 32 名 PCP（59%的内科医生和 41%的家庭医生）从业时间超过 10 年（97%），超过 94%的时间用于临床护理，在私人（69%）或多专科小组实践（16%）环境中执业。PCP 最常提到的有效管理 CKD 患者的障碍主要集中在与肾病医生建立工作伙伴关系的困难上，包括（1）缺乏及时的充分信息交流（例如，未收到咨询记录或 CKD 护理计划不清楚）；（2）PCP 和肾病医生之间的角色和责任不明确；（3）获得肾病医生的机会有限（例如，无法及时获得咨询或在有疑问时无法方便地联系肾病医生）。PCP 表示希望“更好的沟通工具”（例如，共享电子病历）和明确的 CKD 护理计划，以促进 PCP-肾病学合作。
结论
促进及时充分信息交流、明确 PCP 和肾病医生之间的角色和责任以及增加获得专家建议的机会，可能会改善 CKD 患者的共同管理。
Zotero 插件