Patient Perceptions of a Population Health Management Program to Improve Kidney Care: Optimizing care in CKD

Abstract

Rationale & Objective

A population health management intervention for a pragmatic cluster randomized control trial (Kidney CHAMP) aimed to improve care and outcomes in patients with chronic kidney disease (CKD) at high-risk of progression to dialysis dependence but not seeing a nephrologist. The Kidney CHAMP intervention provided comanagement support to primary care providers by nephrology electronic-consult, pharmacist-directed medication reconciliation, and nurse-delivered CKD patient education. We sought to learn patient perceptions of Kidney CHAMP intervention and whether the intervention improved their understanding of CKD.

Study Design

An ancillary study of Kidney CHAMP using qualitative methods.

Setting & Participants

Participants were sampled from Kidney CHAMP intervention group using 3 predefined strata (racial/ethnic minorities, low socioeconomic status, and multimorbidities) from May 2021 to February 2022.

Analytical Approach

We conducted semistructured televideo or telephone interviews that were transcribed and then inductively coded by 2 data analysts until thematic saturation was reached. Conventional content and thematic analyses were performed.

Results

In 45 patient interviews (mean age 75 ± 8 years, 44% women, 9% non-White race, and 59% low socioeconomic status), we identified 4 themes. First, patients expressed support for CKD comanagement by the primary care providers (PCPs) and nephrology team. Second, education sessions had variable effect on improving patients’understanding of CKD and its health implications. Third, patients’ self-efficacy and understanding of CKD management varied and was influenced by their understanding of its health implications. Fourth, patients appreciated education sessions and wanted more frequent sessions and actionable individualized guidance.

Limitations

Low representation of non-White individuals, recall bias, and lack of validated measures for health literacy, patient knowledge, and activation.

Conclusions

Patients with CKD who are managed by their PCP were supportive of remote comanagement by a nephrologist. Patients perceive some aspects of CKD health education to be beneficial; however, more effective approaches to communicating risk of CKD development and progression are needed.

Plain-Language Summary

In this ancillary qualitative study, we aimed to learn patient perspectives on a population health management approach to kidney disease comanagement between primary care providers and a multidisciplinary nephrology team. Patient interviewees were supportive of communication between primary care providers and the nephrology specialists, and most appreciated nurse-provided education sessions. However, despite exposure to the same standardized kidney education, interviewees demonstrated variable understandings of kidney disease and its health implications. Suggestions to improve the educational sessions included providing actionable individualized guidance and more frequent sessions.