Embedding effective renal care: Understanding and improving the management of chronic kidney disease in primary care

GPs have been incentivised to record and monitor patients who have mild chronic kidney disease (CKD) to enable early identification of those at risk of further decline. However, relatively few people with early stage CKD will progress to the later stages of kidney disease, so some patients may be being unduly medicalised. The study aimed to explore clinicians’ and patients’ experiences of discussing early stage CKD in primary care. Interviews were conducted with 45 patients and 25 clinicians.

The introduction of ‘CKD’ as a new disease construct conflicted with many clinicians’ values and personal understandings of general practice medicine. Clinicians often avoided using ‘CKD’ when talking to their patients with early stage kidney impairment to avoid causing unnecessary anxiety. Patients’ accounts echoed the phrases described by health professionals. However, patient interpretations showed some phrases to be unhelpful, raising further questions and leaving patients concerned and wanting to know more about possible causes, the meaning of test results, the implications for them and whether they could do anything to prevent further decline.
Some clinicians’ strategies for delivering diagnostic information to patients with early stage CKD are ineffective in helping patients understand their condition. Attempting to reassure patients that their kidney impairment was nothing to worry about, without providing further explanation can add to, rather than diminish, initial concerns. Our findings provide an understanding of why clinical guidelines are not always adhered to for virtuous and complex reasons.
Patients can visit http://www.healthtalk.org/kidney-healthand watch video clips from interviews with people talking about their experiences of early stage CKD and learn about why kidney performance may begin to decline and who is at risk, how kidney performance is measured and why it is important to check it regularly. Patients can also learn about how people find out that they have early signs of kidney problems, their experiences of having regular check-ups, their information preferences, and the ways in which they try to look after their health.
For health professionals, http://www.healthtalk.org/kidney-health provides an insight into the experiences of people who are being monitored for early signs of kidney problems – what information they have received, what they found helpful and unhelpful, their key questions and concerns, and their views on how monitoring could be made more meaningful to them.