Guidelines or mindlines? - implementing a new CKD guideline in German primary care.

IF 2 Q2 MEDICINE, GENERAL & INTERNAL
Konrad Laker, Tim Bothe, Natalie Ebert, Christoph Heintze, Elke Schaeffner, Karen Krüger
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引用次数: 0

Abstract

Background: The development of clinical guidelines aimed at GPs is a key strategy to improving the management of chronic kidney disease (CKD). In 2019, the first CKD guideline aimed specifically at GPs practicing in Germany was published by the German College of General Practitioners and Family Physicians (DEGAM.) AIMS: The aim of this study is to identify the barriers and enablers for the implementation of this guideline. The results of this project, together with quantitative evaluation against quality indicators for CKD in primary care will inform an update to the guideline.

Methods: We performed 17 semi-structured interviews with GPs practicing in Berlin and Brandenburg. Transcripts were analysed using qualitative content analysis as described by Mayring.

Results: We found that the perception of low clinical priority of CKD compared to other chronic diseases, opportunity cost of using guidelines, as well as poor patient understanding were significant barriers. GPs expressed that improved graphic design or integration of guideline recommendations in clinical decision support systems were enabling factors. Clinical problems concerning CKD were mostly solved by recourse to informal communication with specialists. GPs reported that they rarely consulted CKD guidelines as an aide to clinical decision making.

Conclusion: The most significant barrier to use was that guidelines were not used as step-by-step decision aide in consultations with patients. Our analysis suggests that informal contact between primary and secondary care is significant conduit for evidence-based information on CKD in German primary care. Implementation projects should support the development of these relationships.

指南还是思维导线?- 在德国基层医疗机构实施新的 CKD 指南。
背景:制定针对全科医生的临床指南是改善慢性肾脏病(CKD)管理的关键策略。2019 年,德国全科医生和家庭医生学院(DEGAM)发布了第一份专门针对在德国执业的全科医生的 CKD 指南。 目的:本研究旨在确定实施该指南的障碍和促进因素。该项目的研究结果以及根据初级医疗中的慢性肾脏病质量指标进行的定量评估将为指南的更新提供依据:我们对柏林和勃兰登堡的全科医生进行了 17 次半结构式访谈。根据 Mayring 的描述,我们采用定性内容分析法对访谈记录进行了分析:结果:我们发现,与其他慢性疾病相比,慢性肾脏病的临床优先级较低、使用指南的机会成本以及患者理解能力较差是主要障碍。全科医生表示,改进图形设计或将指南建议纳入临床决策支持系统是有利因素。有关慢性肾脏病的临床问题大多通过与专家进行非正式交流来解决。全科医生表示,他们很少参考 CKD 指南作为临床决策的辅助工具:结论:使用指南的最大障碍是,在与患者会诊时,指南没有被用作逐步决策的辅助工具。我们的分析表明,基层医疗机构和二级医疗机构之间的非正式接触是德国基层医疗机构获取有关慢性肾脏病循证信息的重要渠道。实施项目应支持这些关系的发展。
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CiteScore
4.40
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