Abstract
Background/Aims Improving both awareness and identification of chronic kidney disease (CKD) is important among primary care providers so they can provide appropriate clinical care; one method that has been widely embraced is the use of automated reporting of estimated glomerular filtration rate (eGFR) by clinical laboratories. We undertook a qualitative study to examine how clinicians responded to the onset of automated reporting of eGFR at Kaiser Permanente Northwest (KPNW).
Methods We conducted 19 semi-structured interviews among primary care clinicians including both physicians (n=13) and allied health providers (n=6), recruited from KPNW, a non-profit health maintenance organization. Interviews were approximately 30–45 minutes in length, audio-recorded and transcribed. A standard, qualitative content analysis approach was employed.
Results Clinicians generally held favorable views toward automated eGFR reporting as useful information they wish they had easy access to previously. Most (n=15) reported using the eGFR in conjunction with serum creatinine in their clinical decision-making. Benefits of the automated eGFR reporting included saving valuable clinic time in not having to calculate it on their own, increased awareness of and attention to tracking CKD stages, and improved patient care. Increased patient education and counseling on CKD prevention and kidney health was reported by 10 of the clinicians interviewed, and 14 reported minor increases in their referral to Nephrology. Challenges experienced as a result of the automated eGFR reporting included managing patient confusion or fear from the reporting, and increased workload. Suggested improvements included offering yearly trainings on CKD management, providing regular feedback from Nephrology about appropriateness of clinician referral request, improving the integration of eGFR value with other tools in the electronic medical record, and providing tools to facilitate discussion of eGFR findings with patients.
Discussion Overall, clinicians used automated eGFR as a tool to help identify CKD stage, educate and counsel patients about their kidney function and health, and make treatment decisions. The manner in which clinicians use eGFRs appears to be more complex than previously understood, and our study illustrates some of the efforts that might be usefully undertaken (e.g. specific clinician education) when encouraging further promulgation of eGFR reporting and usage.
