Kidney failure risk equation (KFRE), A risk-based triage for nephrology referrals: A mixed-methods study at pre-implementation phase among healthcare providers.

Background: Chronic kidney disease (CKD) poses a significant health challenge globally. There is limited understanding of the challenges and opportunities to enhance CKD management from the perspectives of healthcare providers (HCPs) involved in the direct care of patients with CKD. To integrate a risk-based triage for nephrology referrals, namely the kidney failure risk equation (KFRE), we explored HCPs' perspectives on the facilitators and barriers to CKD management before the implementation of KFRE.

Methods: We used a mixed methods approach to explore HCPs' perspectives on the 1) facilitators and barriers to CKD management and 2) perceived benefits and challenges of implementing KFRE, a risk-based triage to guide nephrology referrals at the Universiti Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. Interviews were audio recorded, transcribed verbatim, and thematically analyzed. Quantitatively, provider job satisfaction surveys were performed.

Results: Overall, 111 HCPs completed the surveys, with the majority being mostly satisfied with the physical surroundings, co-workers, and supervision received. Mixed responses were expressed about the amount of work and equipment provided. Interviews were conducted among 27 HCPs from the three main CKD care provider groups (primary care medicine, nephrology, and endocrinology). The facilitators' and barriers' themes were identified. The top three barriers to CKD management were suboptimal patients' insights, gaps in practices and confidences, and shortfalls in the healthcare system. By contrast, a good interdisciplinary network and accessibility to specialist resources were the key facilitators. They underscored the importance of human resources empowerment, continuous patient education, and structured interdisciplinary collaboration. HCPs perceived risk-based triage using the KFRE as potentially useful for more targeted care.

Conclusion: We identified several modifiable barriers and facilitators warranting attention to improve the health outcomes of people with CKD. A risk-based triage approach using the KFRE appears promising in facilitating targeted nephrology referrals for better care and resource allocations.