Primary Care Physicians' Practices and Barriers in Evaluating and Managing Chronic Kidney Disease in New Providence, The Bahamas

Abstract

Objectives: To assess the practices and barriers in evaluating and managing chronic kidney disease among primary care physicians in New Providence, The Bahamas. Methods: A cross-sectional study utilizing an anonymous, self administered questionnaire was given to General Practitioners, Family Medicine, and Internal Medicine physicians after using a simple random sampling approach. Descriptive and inferential statistical analysis was conducted using IBM SPSS software. Results: There were 119 physicians in this study with Family Medicine specialty area representing 52.1%. Seventy-four (74) physicians reported following CKD guidelines. The most common at-risk groups identified were Diabetes Mellitus (100%), Hypertension (98.3%), and use of nephrotoxic agents (97.5%). The most common diagnostic test used to identify CKD was eGFR (97.5%) and 72.2% of physicians used eGFR alone to stage CKD. Physicians overall agreed (40.3 - 50.4%) they were comfortable in diagnosing and managing CKD and its complications except for bone disorders (43.2%) and metabolic acidosis (34.7%) where responses were neutral. Physicians were neutral in having tools/resources to help them manage bone disorders (35.3%) and metabolic acidosis (31.9%) and disagreed to having educational tools for patients to understand bone disorders (32.2%) and metabolic acidosis (32.8%). Physicians agreed-strongly agreed with 12 of 13 perceived barriers, and there were 26 unique barriers expressed (8 patient-level, 7 provider-level, 11 systems-level). Conclusions: Deficits in the evaluation and management of CKD, and numerous barriers to CKD care were discovered. Recommendations include the development of a national CKD guideline, local CKD continuous medical education seminars, and public health campaigns on CKD education.