巴哈马新普罗维登斯初级保健医生在评估和管理慢性肾脏病方面的做法和障碍

Wilnaye A Bain, Sabriquet Pinder-Butler, Terrance Fountain, Ilsa Grant
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摘要

目的评估巴哈马新普罗维登斯初级保健医生在评估和管理慢性肾病方面的做法和障碍。方法: 采用匿名自填问卷的方式进行横断面研究:采用简单随机抽样方法,向全科医师、家庭医生和内科医生发放匿名自制问卷,进行横断面研究。使用 IBM SPSS 软件进行了描述性和推论性统计分析。结果本研究共有 119 名医生参与,其中家庭医学专业占 52.1%。74名医生表示遵循了慢性肾脏病指南。最常见的高危人群是糖尿病(100%)、高血压(98.3%)和使用肾毒性药物(97.5%)。最常用的诊断检查是 eGFR(97.5%),72.2% 的医生仅使用 eGFR 对 CKD 进行分期。除骨质紊乱(43.2%)和代谢性酸中毒(34.7%)外,医生总体上同意(40.3% - 50.4%)他们在诊断和管理慢性肾脏病及其并发症方面感到得心应手,但对骨质紊乱(43.2%)和代谢性酸中毒(34.7%)则持中立态度。医生对是否有工具/资源帮助他们管理骨病(35.3%)和代谢性酸中毒(31.9%)持中立态度,不同意为患者提供了解骨病(32.2%)和代谢性酸中毒(32.8%)的教育工具。在 13 个感知到的障碍中,医生同意-非常同意的有 12 个,共提出了 26 个独特的障碍(患者层面 8 个,医疗服务提供者层面 7 个,系统层面 11 个):结论:发现了慢性肾脏病评估和管理方面的缺陷,以及慢性肾脏病护理方面的众多障碍。建议包括制定国家慢性肾脏病指南、举办地方性慢性肾脏病继续医学教育研讨会以及开展有关慢性肾脏病教育的公共卫生运动。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Primary Care Physicians' Practices and Barriers in Evaluating and Managing Chronic Kidney Disease in New Providence, The Bahamas
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.
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