Primary Care Center El Pla. Servei d'Atenció Primària Baix Llobregat Centre, Atenció Primària Metropolitana Sud, Institut Català de la Salut, Sant Feliu de Llobregat, Barcelona, 08980, Spain.
Research Group On Disease, Cardiovascular Risk and Lifestyles in Primary Care, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, 08007, Spain.
BMC Prim Care. 2024 May 21;25(1):177. doi: 10.1186/s12875-024-02418-0.
Advanced chronic kidney disease (ACKD) is associated with a high risk of adverse cardiovascular and renal events and has a significant impact on quality of life and life expectancy. Several studies have identified areas for improvement in their management in primary care. Some professional and environmental factors can act as key barriers to appropriate care.
To analyse attitudes, subjective norms, and perceived behavioural control among primary care professionals related to the implementation of an evidence-based approach for individuals with ACKD in primary care.
This was a qualitative study using an interpretative phenomenological approach based on the theory of planned behaviour. Two aspects of the evidence-based approach were explored: the implementation of clinical practice guidelines and the utilisation of electronic kidney disease records within the scope of this study. Primary care nurses and physicians participated in a previous pilot interview and five focus groups. Subsequently, a thematic analysis of the gathered data was conducted.
Thirty-three primary care professionals participated. The emerging themes included: experiences in the management of ACKD (highlighting a distinct profile of older, frail patients with comorbidities masking CKD and a CKD follow-up primarily focused on analytical monitoring and drug adjustment); factors in the professional environment influencing the use of scientific evidence (such as time constraints, excessive electronic health records, and unfamiliar reference guidelines); attitudes towards the application of recommendations on ACKD (recognising limitations of computer systems despite considering them as guidance); and capacities to implement evidence-based recommendations (acknowledging formative needs and challenges in coordinating care with nephrology services).
Several psychological elements identified through the TBP hinder the adequate implementation of an evidence-based approach for individuals with CKD. Attitudes have been identified as factors modulating the use of standardised electronic records. Instead, subjective norms (influences from the professional environment) and perceived behavioral control (perception of capabilities) acted as barriers to the proper application of clinical practice guidelines and standardised records.
Strategies aimed at optimising the management of people with ACKD should focus not only on training but also on improving attitudes, organisational structures, IT systems and coordination between primary care and nephrology.
慢性肾脏病后期（ACKD）与不良心血管和肾脏事件风险增加相关，并对生活质量和预期寿命有重大影响。一些研究已经确定了初级保健中改善其管理的领域。一些专业和环境因素可能是适当护理的关键障碍。
分析初级保健专业人员与实施基于证据的 ACKD 患者初级保健方法相关的态度、主观规范和感知行为控制。
这是一项基于计划行为理论的定性研究，采用解释现象学方法。本研究探讨了基于证据的方法的两个方面：临床实践指南的实施和电子肾脏病记录的利用。初级保健护士和医生参加了之前的试点访谈和五个焦点小组。随后，对收集到的数据进行主题分析。
33 名初级保健专业人员参与了研究。出现的主题包括：ACKD 管理经验（突出了具有合并症的老年、虚弱患者的明显特征，掩盖了 CKD，CKD 随访主要集中在分析监测和药物调整上）；影响科学证据使用的专业环境因素（如时间限制、过多的电子健康记录和不熟悉的参考指南）；对 ACKD 应用建议的态度（尽管认为计算机系统是指导，但认识到它们的局限性）；以及实施基于证据的建议的能力（承认在与肾病服务协调护理方面的形成性需求和挑战）。
通过 TBP 确定的一些心理因素阻碍了基于证据的 CKD 患者方法的充分实施。态度被确定为影响标准化电子记录使用的因素。相反，主观规范（来自专业环境的影响）和感知行为控制（对能力的感知）是适当应用临床实践指南和标准化记录的障碍。
旨在优化 ACKD 患者管理的策略不仅应侧重于培训，还应侧重于改善态度、组织结构、IT 系统以及初级保健与肾病学之间的协调。
