School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia.
Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia.
BMC Nephrol. 2020 Mar 12;21(1):83. doi: 10.1186/s12882-020-01731-x.
Chronic kidney disease (CKD) is growing population health concern worldwide, and with early identification and effective management, kidney disease progression can be slowed or prevented. Most patients with risk factors for chronic kidney disease are treated within primary healthcare. Therefore, it is important to understand how best to support primary care providers (PC-P) to detect and manage chronic kidney disease. The aim of this systematic review was to evaluate barriers and enablers to the diagnosis and management of CKD in primary care.
A systematic review of qualitative research on the barriers and/or enablers to detection and/or management of CKD in adults within primary healthcare was conducted. The databases Medline (EBSCO), PubMed, Cochrane CENTRAL, CINAHL (EBSCO) and Joanna Briggs Institute Evidence Based Practice (Ovid) were searched until 27th August 2019. Barriers and/or enablers reported in each study were identified, classified into themes, and categorised according to the Theoretical Domains Framework.
A total of 20 studies were included in this review. The most commonly reported barriers related to detection and management of CKD in primary care were categorised into the 'Environmental context and resources' domain (n = 16 studies). Overall, the most common barrier identified was a lack of time (n = 13 studies), followed by a fear of delivering a diagnosis of CKD, and dissatisfaction with CKD guidelines (both n = 10 studies). Overall, the most common enabler identified was the presence of supportive technology to identify and manage CKD (n = 7 studies), followed by the presence of a collaborative relationship between members of the healthcare team (n = 5 studies).
This systematic review identified a number of barriers and enablers which PC-P face when identifying and managing CKD. The findings of this review suggest a need for time-efficient strategies that promote collaboration between members of the healthcare team, and practice guidelines which consider the frequently co-morbid nature of CKD. Enhanced collaboration between PC-P and nephrology services may also support PC-Ps when diagnosing CKD in primary care, and facilitate improved patient self-management.
慢性肾脏病（CKD）是全球日益严重的人群健康问题，通过早期识别和有效管理，可以减缓或预防肾脏病的进展。大多数有慢性肾脏病风险因素的患者在初级医疗保健中接受治疗。因此，了解如何最好地支持初级保健提供者（PC-P）来检测和管理慢性肾脏病非常重要。本系统评价的目的是评估初级保健中检测和管理慢性肾脏病的障碍和促进因素。
对初级医疗保健中成年人慢性肾脏病检测和/或管理的障碍和/或促进因素的定性研究进行系统评价。检索了 Medline（EBSCO）、PubMed、Cochrane 中心、CINAHL（EBSCO）和 Joanna Briggs 循证实践（Ovid）数据库，直到 2019 年 8 月 27 日。在每一项研究中报告的障碍和/或促进因素被识别出来，分类为主题，并根据理论领域框架进行分类。
本综述共纳入 20 项研究。在初级医疗保健中检测和管理 CKD 时，最常报告的障碍被归类为“环境背景和资源”领域（n=16 项研究）。总体而言，最常见的障碍是缺乏时间（n=13 项研究），其次是害怕诊断 CKD，以及对 CKD 指南不满意（均为 n=10 项研究）。总体而言，最常见的促进因素是识别和管理 CKD 的支持性技术的存在（n=7 项研究），其次是医疗团队成员之间协作关系的存在（n=5 项研究）。
本系统评价确定了 PC-P 在识别和管理 CKD 时面临的一些障碍和促进因素。本研究结果表明，需要有效的时间管理策略来促进医疗团队成员之间的协作，以及考虑到 CKD 经常并发的性质的实践指南。增强 PC-P 和肾病学服务之间的协作也可能支持 PC-P 在初级保健中诊断 CKD，并促进改善患者的自我管理。
