Understanding the management of early-stage chronic kidney disease in primary care: a qualitative study
Open accessAbstract
BACKGROUND: Primary care is recognised to have an important role in the delivery of care for people with chronic kidney disease (CKD). However, there is evidence that CKD management is currently suboptimal, with a range of practitioner concerns about its management. AIM: To explore processes underpinning the implementation of CKD management in primary care. DESIGN AND SETTING: Qualitative study in general practices participating in a chronic kidney disease collaborative undertaken as part of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester. METHOD: Semi-structured interviews were conducted with GPs and practice nurses (n = 21). Normalisation Process Theory provided a framework for generation and analysis of the data. RESULTS: A predominant theme was anxiety about the disclosure of early-stage CKD with patients. The tensions experienced related to identifying and discussing CKD in older people and patients with stage 3A, embedding early-stage CKD within vascular care, and the distribution of work within the practice team. Participants provided accounts of work undertaken to resolve the difficulties encountered, with efforts having tended to focus on reassuring patients. Analysis also highlighted how anxiety surrounding disclosure influenced, and was shaped by, the organisation of care for people with CKD and associated long-term conditions. CONCLUSION: Offering reassurance alone may be of limited benefit, and current management of early-stage CKD in primary care may miss opportunities to address susceptibility to kidney injury, improve self-management of vascular conditions, and improve the management of multimorbidity.
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In the CKD case, some GPs and practice nurses viewed declining renal function as a natural part of ageing and believed that disclosing a diagnosis of CKD could cause unnecessary anxiety in patients, potentially missing opportunities to improve self-management and overall management of cardiovascular disease and to address increased susceptibility to acute kidney injury.
“This was particularly the case for older patients as some General Practitioners (GPs) and practice nurses viewed declining renal function as a natural part of ageing and believed that disclosing a diagnosis of CKD could cause unnecessary anxiety in patients. By adopting this approach, opportunities to improve self-management and overall management of cardiovascular disease and to address the issue”
From PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice (2015) · cites this paper as [41]
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Understanding risk stratification of chronic kidney disease: a qualitative study in primary care
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- Authors
- Blakeman, T., Protheroe, J., Chew-Graham, C., Rogers, A., & Kennedy, A.
- Affiliations
- University of Manchester (GB)
- Venue
- British Journal of General Practice
- Published
- 2012-04
- Volume
- 62
- Issue
- 597
- Pages
- e233-e242
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC3310029
- OpenAlex
- W2122850558
- Cited by
- 96
- References
- 28
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 7 · 2023: 3 · 2022: 6 · 2021: 3 · 2020: 14 · 2019: 6 · 2018: 13 · 2017: 3 · 2016: 10 · 2015: 9 · 2014: 7 · 2013: 9 · 2012: 1
- FWCI
- 14.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- National Institute for Health and Care Research (CL-2009-06-004)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- early chronic kidney disease, CKD management, primary care, general practitioners, practice nurses, patient disclosure, patient reassurance, older adults, vascular care, multimorbidity, work distribution, chronic disease, implementation of care
- MeSH terms
- Adult, Anxiety, Attitude of Health Personnel, Delivery of Health Care, England, Female, Humans, Male, Middle Aged, Nurse Practitioners, Patient Education as Topic, Physician-Patient Relations, Professional Practice, Disclosure, Renal Insufficiency, Chronic, General Practice
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