HEFT Repository

GPs' views on managing advanced chronic kidney disease in primary care: a qualitative study.

Tonkin-Crine, Sarah and Santer, Miriam and Leydon, Geraldine M and Murtagh, Fliss Em and Farrington, Ken and Caskey, Fergus and Rayner, Hugh and Roderick, Paul (2015) GPs' views on managing advanced chronic kidney disease in primary care: a qualitative study. The British journal of general practice : the journal of the Royal College of General Practitioners, 65 (636). e469-77. ISSN 1478-5242. This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs

Full text not available from this repository.
Official URL: http://bjgp.org/content/65/636/e469.long

Abstract

BACKGROUND

Chronic kidney disease (CKD) has become a significant part of the GP's workload since the introduction of the National Institute for Health and Care Excellence guidelines in 2008. Patients with advanced CKD (stages G4 and G5) often have comorbidities, varied disease progression, and are likely to be older. GPs may experience difficulties with management decisions for patients with advanced CKD, including when to refer to nephrology.

AIM

To explore GPs' views of managing patients with advanced CKD and referral to secondary care.

DESIGN AND SETTING

Qualitative study with GPs in four areas of England: London, Bristol, Birmingham, and Stevenage.

METHOD

Semi-structured interviews with 19 GPs. Transcribed interviews were thematically analysed.

RESULTS

GPs had little experience of managing patients with advanced CKD, including those on dialysis or having conservative care (treatment without dialysis or a transplant), and welcomed guidance. Some GPs referred patients based on renal function alone and some used wider criteria including age and multimorbidity. GPs reported a tension between national guidance and local advice, and some had learnt from experience that patients were discharged back to primary care. GPs with more experience of managing CKD referred patients later, or sometimes not at all, if there were no additional problems and if dialysis was seen as not in the patient's interests.

CONCLUSION

GPs want guidance on managing older patients with advanced CKD and comorbidities, which better incorporates agreement between local and national recommendations to clarify referral criteria. GPs are not generally aware of conservative care programmes provided by renal units, however, they appear happy to contribute to such care or alternatively, lead conservative management with input from renal teams.

Item Type: Article
Additional Information: This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs
Subjects: WJ Urogenital system. Urology
Divisions: Emergency Services > Renal
Related URLs:
Depositing User: Mrs Yolande Brookes
Date Deposited: 20 Aug 2015 13:26
Last Modified: 20 Aug 2015 13:26
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1021

Actions (login required)

View Item View Item