Subash Aishwarya, Levinson Maya, Bonnet Kemberlee, Hall Rasheeda K, Saeed Fahad, Liu Christine K, Chatterjee Totini S, Mixon Amanda S, Gould Edward R, Horst Sara N, Umeukeje Ebele M, Burdick Rachel A, Taylor Warren D, Cavanaugh Kerri L, Schlundt David G, Nair Devika
Rutgers New Jersey Medical School, Newark, New Jersey.
Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee.
Clin J Am Soc Nephrol. 2025 May 1;20(5):652-664. doi: 10.2215/CJN.0000000658. Epub 2025 Mar 14.
Addressing geriatric syndromes in CKD likely requires implementation of an interdisciplinary model of care. Experts shared multilevel barriers to implementation of this model and strategies to mitigate each barrier. Experts felt that patient satisfaction and clinician burnout could improve with implementing interdisciplinary care in CKD.
Despite their prevalence, prognostic significance, and prioritization by patients, key geriatric syndromes, such as cognitive impairment, frailty, and depression, are not routinely addressed in CKD care in the United States (US). In an interdisciplinary care model, health professionals with diverse expertise collaborate to address all symptoms and functional impairments occurring alongside a patient's chronic disease. Thus, routinely addressing geriatric syndromes in CKD may require implementing this evidence-based model of care and adapting it to the needs of patients with CKD. In a formative step to understanding how health systems could implement an interdisciplinary model of care to address geriatric syndromes in CKD, we interviewed health professionals around the world with relevant expertise.
We conducted a qualitative study informed by the Consolidated Framework for Implementation Research. We interviewed nephrologists, administrators, geriatricians, palliative medicine specialists, subspecialists, and allied health professionals working in other interdisciplinary clinics from the United States, United Kingdom, India, and Canada. We analyzed results using an inductive-deductive approach.
Thematic saturation occurred at 42 experts. Three major domains emerged: barriers to implementation, strategies to mitigate barriers, and benefits of implementation. Barriers were categorized into overarching themes related to () aging-friendly policy and workforce availability, () organizational culture and structure, and () nephrologist and patient perceptions. Strategies to mitigate barriers were categorized into themes related to () demonstrating viability, () facilitating effective health communication, () soliciting support from administrators and clinicians, and () expanding the base for patient information and treatment evidence. Proposed benefits of implementation included improved shared decision making and reduced nephrologist burnout.
Implementing an interdisciplinary model of care that addresses geriatric syndromes in CKD is possible but will require overcoming policy-related, financial, cultural, and structural barriers. Such a model of care may ultimately benefit patients and nephrologists.
解决慢性肾脏病中的老年综合征可能需要实施跨学科护理模式。专家们分享了实施该模式的多层次障碍以及减轻各障碍的策略。专家们认为，在慢性肾脏病中实施跨学科护理可提高患者满意度并缓解临床医生的职业倦怠。
尽管老年综合征普遍存在、具有预后意义且受到患者重视，但在美国的慢性肾脏病护理中，诸如认知障碍、衰弱和抑郁等关键老年综合征并未得到常规处理。在跨学科护理模式中，具有不同专业知识的卫生专业人员协作解决与患者慢性病同时出现的所有症状和功能障碍。因此，在慢性肾脏病中常规处理老年综合征可能需要实施这种循证护理模式并使其适应慢性肾脏病患者的需求。作为了解卫生系统如何实施跨学科护理模式以解决慢性肾脏病中的老年综合征的一个形成性步骤，我们采访了世界各地具有相关专业知识的卫生专业人员。
我们开展了一项基于实施研究综合框架的定性研究。我们采访了来自美国、英国、印度和加拿大的肾病学家、管理人员、老年病学家、姑息医学专家、亚专科医生以及在其他跨学科诊所工作的专职医疗人员。我们采用归纳 - 演绎方法分析结果。
42位专家时达到主题饱和。出现了三个主要领域：实施障碍、减轻障碍的策略以及实施的益处。障碍被归类为与（）老龄友好政策和劳动力可得性、（）组织文化和结构以及（）肾病学家和患者认知相关的总体主题。减轻障碍的策略被归类为与（）证明可行性、（）促进有效的健康沟通、（）寻求管理人员和临床医生的支持以及（）扩大患者信息和治疗证据基础相关的主题。实施的预期益处包括改善共同决策和减轻肾病学家的职业倦怠。
实施解决慢性肾脏病中老年人综合征的跨学科护理模式是可行的，但需要克服与政策、财务、文化和结构相关的障碍。这样的护理模式最终可能使患者和肾病学家受益。
