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Perceived Benefits and Challenges of a Risk-Based Approach to Multidisciplinary Chronic Kidney Disease Care: A Qualitative Descriptive Study

BACKGROUND: The kidney failure risk equation (KFRE) provides an estimate of risk of progression to kidney failure, and may guide clinical care. OBJECTIVE: We aimed to describe patient, family, and health care provider’s perspectives of the perceived benefits and challenges of using a risk-based appr...

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Autores principales: Smekal, Michelle D., Tam-Tham, Helen, Finlay, Juli, Donald, Maoliosa, Benterud, Eleanor, Thomas, Chandra, Quinn, Robert R., Tam, Kin, Manns, Braden J., Tonelli, Marcello, Bello, Aminu, Tangri, Navdeep, Hemmelgarn, Brenda R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5888822/
https://www.ncbi.nlm.nih.gov/pubmed/29636981
http://dx.doi.org/10.1177/2054358118763809
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author Smekal, Michelle D.
Tam-Tham, Helen
Finlay, Juli
Donald, Maoliosa
Benterud, Eleanor
Thomas, Chandra
Quinn, Robert R.
Tam, Kin
Manns, Braden J.
Tonelli, Marcello
Bello, Aminu
Tangri, Navdeep
Hemmelgarn, Brenda R.
author_facet Smekal, Michelle D.
Tam-Tham, Helen
Finlay, Juli
Donald, Maoliosa
Benterud, Eleanor
Thomas, Chandra
Quinn, Robert R.
Tam, Kin
Manns, Braden J.
Tonelli, Marcello
Bello, Aminu
Tangri, Navdeep
Hemmelgarn, Brenda R.
author_sort Smekal, Michelle D.
collection PubMed
description BACKGROUND: The kidney failure risk equation (KFRE) provides an estimate of risk of progression to kidney failure, and may guide clinical care. OBJECTIVE: We aimed to describe patient, family, and health care provider’s perspectives of the perceived benefits and challenges of using a risk-based approach to guide care delivery for patients with advanced chronic kidney disease (CKD), and refine implementation based on their input. METHODS: We used qualitative methodology to explore perceived benefits and challenges of implementing a risk-based approach (using the KFRE) to determine eligibility for multidisciplinary CKD care in Southern Alberta. We obtained perspectives from patients and families through focus groups, as well as input from health care providers through interviews and open-ended responses from an online survey. Twelve patients/family members participated in 2 focus groups, 16 health care providers participated in an interview, and 40 health care providers responded to the survey. RESULTS: Overall, participants felt that a KFRE-based approach had the potential to improve efficiency of the clinics by targeting care to patients at highest risk of kidney failure; however, they also expressed concerns about the impact of loss of services for lower risk individuals. Participants also articulated concerns about a perceived lack of capacity for adequate CKD patient care in the community. Our implementation strategy was modified as a result of participants’ feedback. CONCLUSIONS: We identified benefits and challenges to implementation of a risk-based approach to guide care of patients with advanced CKD. Based on these results, our implementation strategy has been modified by removing the category of referral back to primary care alone, and instead having that decision made jointly by nephrologists and patients among low-risk patients.
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spelling pubmed-58888222018-04-10 Perceived Benefits and Challenges of a Risk-Based Approach to Multidisciplinary Chronic Kidney Disease Care: A Qualitative Descriptive Study Smekal, Michelle D. Tam-Tham, Helen Finlay, Juli Donald, Maoliosa Benterud, Eleanor Thomas, Chandra Quinn, Robert R. Tam, Kin Manns, Braden J. Tonelli, Marcello Bello, Aminu Tangri, Navdeep Hemmelgarn, Brenda R. Can J Kidney Health Dis Original Research Article BACKGROUND: The kidney failure risk equation (KFRE) provides an estimate of risk of progression to kidney failure, and may guide clinical care. OBJECTIVE: We aimed to describe patient, family, and health care provider’s perspectives of the perceived benefits and challenges of using a risk-based approach to guide care delivery for patients with advanced chronic kidney disease (CKD), and refine implementation based on their input. METHODS: We used qualitative methodology to explore perceived benefits and challenges of implementing a risk-based approach (using the KFRE) to determine eligibility for multidisciplinary CKD care in Southern Alberta. We obtained perspectives from patients and families through focus groups, as well as input from health care providers through interviews and open-ended responses from an online survey. Twelve patients/family members participated in 2 focus groups, 16 health care providers participated in an interview, and 40 health care providers responded to the survey. RESULTS: Overall, participants felt that a KFRE-based approach had the potential to improve efficiency of the clinics by targeting care to patients at highest risk of kidney failure; however, they also expressed concerns about the impact of loss of services for lower risk individuals. Participants also articulated concerns about a perceived lack of capacity for adequate CKD patient care in the community. Our implementation strategy was modified as a result of participants’ feedback. CONCLUSIONS: We identified benefits and challenges to implementation of a risk-based approach to guide care of patients with advanced CKD. Based on these results, our implementation strategy has been modified by removing the category of referral back to primary care alone, and instead having that decision made jointly by nephrologists and patients among low-risk patients. SAGE Publications 2018-03-23 /pmc/articles/PMC5888822/ /pubmed/29636981 http://dx.doi.org/10.1177/2054358118763809 Text en © The Author(s) 2018 http://www.creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research Article
Smekal, Michelle D.
Tam-Tham, Helen
Finlay, Juli
Donald, Maoliosa
Benterud, Eleanor
Thomas, Chandra
Quinn, Robert R.
Tam, Kin
Manns, Braden J.
Tonelli, Marcello
Bello, Aminu
Tangri, Navdeep
Hemmelgarn, Brenda R.
Perceived Benefits and Challenges of a Risk-Based Approach to Multidisciplinary Chronic Kidney Disease Care: A Qualitative Descriptive Study
title Perceived Benefits and Challenges of a Risk-Based Approach to Multidisciplinary Chronic Kidney Disease Care: A Qualitative Descriptive Study
title_full Perceived Benefits and Challenges of a Risk-Based Approach to Multidisciplinary Chronic Kidney Disease Care: A Qualitative Descriptive Study
title_fullStr Perceived Benefits and Challenges of a Risk-Based Approach to Multidisciplinary Chronic Kidney Disease Care: A Qualitative Descriptive Study
title_full_unstemmed Perceived Benefits and Challenges of a Risk-Based Approach to Multidisciplinary Chronic Kidney Disease Care: A Qualitative Descriptive Study
title_short Perceived Benefits and Challenges of a Risk-Based Approach to Multidisciplinary Chronic Kidney Disease Care: A Qualitative Descriptive Study
title_sort perceived benefits and challenges of a risk-based approach to multidisciplinary chronic kidney disease care: a qualitative descriptive study
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5888822/
https://www.ncbi.nlm.nih.gov/pubmed/29636981
http://dx.doi.org/10.1177/2054358118763809
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