Patient Education for CKD and Decision Support in Primary Care: Findings From the EPIK Pilot Study.

Abstract

Rationale & objective: Chronic kidney disease (CKD) affects millions of people in the United States, yet effective interventions to address gaps in patient knowledge and engagement are not well-established. We developed and pilot tested a brief educational decision aid for patients with CKD who are being treated in primary care settings.

Study design: Pilot quality improvement (QI) study of a decision aid intervention.

Setting & participants: The decision aid was introduced and used in 1 of 2 general internal medicine primary care clinics for adult patients with CKD.

Exposure: An electronic medical record-based patient educational decision aid called the Encounter Decision Intervention (EDI) developed using QI methods and with input from patients and clinicians for use during primary care visits to address a CKD diagnosis and engage patients in their clinical management.

Outcome: Perceived and objective CKD knowledge, CKD-specific stress, and patient satisfaction measured in both primary care clinics as assessed using validated surveys.

Analytical approach: Fisher exact tests, t tests, and Kruskal-Wallis tests were used to detect univariable associations of outcomes with use of the EDI across primary care clinics.

Results: Seventy-four patients completed the study (37 in each clinic). There were no statistically significant differences in patient characteristics between the clinics. The group treated in the clinic that used the EDI had statistically significantly higher satisfaction with their clinicians, with clinician communication, and with their overall care. The patients reported high satisfaction with the EDI, and the clinicians reported favorable usability.

Limitations: A nonrandomized comparison, small sample size, and possible differences across practice settings.

Conclusions: A new integrated educational decision aid was successfully implemented in a primary care setting. Pilot testing suggested that the EDI was associated with higher patient satisfaction with their primary care provider, with their clinician's communication, and with their overall care.

Plain-language summary: Most patients who have chronic kidney disease (CKD) are not aware of their illness. Few studies have explored whether patient education can increase patients' knowledge about CKD or influence patients' satisfaction with the care or communication they receive from their physicians. This study tested whether a short CKD education intervention implemented by the patient's physician was associated with patients' greater awareness of their CKD as well as their satisfaction with care and communication. This pilot study found that a decision aid for patients with CKD was implementable in a primary care setting. Patients who received CKD education felt more satisfied with their care and communication with their physicians compared with patients who did not receive the education.