School of Health and Social Care, London South Bank University, London.
Centre for Primary Care and Public Health, Queen Mary University of London, London.
Br J Gen Pract. 2019 Sep 26;69(687):e715-e723. doi: 10.3399/bjgp19X705497. Print 2019 Oct.
An innovative programme to improve identification and management of chronic kidney disease (CKD) in primary care was implemented across three clinical commissioning groups (CCGs) in 2016. This included a falling estimated glomerular filtration rate (eGFR) trigger tool built from data in the electronic health record (EHR). This tool notifies GP practices of falling eGFR values. By alerting clinicians to patients with possible CKD progression the tool invites clinical review, a referral option, and written reflection on management.
To identify practitioner perceptions of trigger tool use from interviews, and compare these with reflections on clinical management recorded within the tools.
A qualitative analysis set in 136 practices across East London during 2016-2018.
Eight semi-structured interviews with GPs and practice staff were recorded, and thematic analysis was undertaken using framework analysis. The reflective comments recorded in the trigger tools of 1921 cases were categorised by age group, referral status, and by the drop in eGFR (>15 or >25 ml/min).
Three themes emerged from the interviews: getting started, patient safety, and trigger tools for learning. Well-organised practices found the tool was readily embedded into workflow and expressed greater motivation for using it. The tool was seen to support patient safety, and was used for learning about CKD management, both individually and as a practice. Reflective comments from 1921 trigger tools were reviewed. These supported the theme of patient safety. The free-text data, stratified by age, challenged the expectation that younger cases, at higher risk of progressive CKD, would have higher referral rates.
Building electronic trigger tools from the EHR can identify patients with a falling eGFR, prompting review of the eGFR trajectory and management plan. Interview and reflective data illustrated that practice use of the tool supports the patient safety agenda and encourages learning about CKD management.
2016 年，三个临床委托组（CCG）实施了一项创新计划，以改善初级保健中慢性肾脏病（CKD）的识别和管理。这包括一个从电子健康记录（EHR）数据中构建的下降估计肾小球滤过率（eGFR）触发工具。该工具通知 GP 实践下降的 eGFR 值。通过提醒临床医生注意可能进展为 CKD 的患者，该工具邀请进行临床审查、转诊选项，并对管理进行书面反思。
通过访谈确定从业者对触发工具使用的看法，并将这些看法与工具中记录的临床管理反思进行比较。
2016-2018 年，在东伦敦的 136 个实践中进行了定性分析。
记录了 8 名全科医生和实践工作人员的半结构化访谈，并使用框架分析进行了主题分析。对 1921 例病例的触发工具中记录的反思性评论进行了分类，按年龄组、转诊状态和 eGFR 下降（>15 或>25 ml/min）进行分类。
访谈中出现了三个主题：开始、患者安全和触发工具学习。组织良好的实践发现该工具很容易嵌入工作流程，并表示更有动力使用它。该工具被认为支持患者安全，并用于学习 CKD 管理，无论是个人还是作为实践。审查了 1921 个触发工具的反思性评论。这些评论支持了患者安全的主题。按年龄分层的自由文本数据挑战了这样的预期，即年龄较小、进展性 CKD 风险较高的病例转诊率会更高。
从 EHR 构建电子触发工具可以识别 eGFR 下降的患者，提示对 eGFR 轨迹和管理计划进行审查。访谈和反思性数据表明，该工具在实践中的使用支持患者安全议程，并鼓励学习 CKD 管理。
