Abstract
BackgroundPrimary care physicians and other primary health care professionals from Alberta, Canada identified a clinical pathway as a potential tool to facilitate uptake of clinical practice guidelines for the diagnosis, management and referral of adults with chronic kidney disease. We describe the development and implementation of a chronic kidney disease clinical pathway (CKD-CP; www.ckdpathway.ca).MethodsThe CKD-CP was developed and implemented based on the principles of the Knowledge-To-Action Cycle framework. We used a mixed methods approach to identify the usability and feasibility of the CKD-CP. This included individual interviews, an online survey and website analytics, to gather data on barriers and facilitators to use, perceived usefulness and characteristics of users. Results are reported using conventional qualitative content analysis and descriptive statistics.ResultsEighteen individual interviews were conducted with primary care physicians, nephrologists, pharmacists and nurse practitioners to identify themes reflecting both barriers and facilitators to integrating the CKD-CP into clinical practice. Themes identified included: communication, work efficiency and confidence. Of the 159 participants that completed the online survey, the majority (52 %) were first time CKD-CP users. Among those who had previously used the CKD-CP, 94 % agreed or strongly agreed that the pathway was user friendly, provided useful information and increased their knowledge and confidence in the care of patients with CKD. Between November 2014 and July 2015, the CKD-CP website had 10,710 visits, 67 % of which were new visitors. The 3 most frequently visited web pages were home, diagnose and medical management. Canada, Indonesia and the United States were the top 3 countries accessing the website during the 9 month period.ConclusionsAn interactive, online, point-of-care tool for primary care providers can be developed and implemented to assist in the care of patients with CKD. Our findings are important for making refinements to the CKD –CP website via ongoing discussions with end-users and the development team, along with continued dissemination using multiple strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0350-z) contains supplementary material, which is available to authorized users.
Highlights
Primary care physicians and other primary health care professionals from Alberta, Canada identified a clinical pathway as a potential tool to facilitate uptake of clinical practice guidelines for the diagnosis, management and referral of adults with chronic kidney disease
In this paper we describe phases 4 and 5 of the Knowledge-To-Action Cycle, how we developed, implemented and monitored use and feasibility of the Chronic kidney disease (CKD) Clinical Pathway (CKD-CP) (Fig. 1)
Study overview Creation and implementation of the interactive point-ofcare tool (CKD-CP) for primary care providers in Alberta, Canada was undertaken to assist them in three aspects of CKD care: diagnosis, management and referral
Summary
Primary care physicians and other primary health care professionals from Alberta, Canada identified a clinical pathway as a potential tool to facilitate uptake of clinical practice guidelines for the diagnosis, management and referral of adults with chronic kidney disease. Clinical practice guidelines are intended to address evidencepractice gaps, translating evidence into primary care can be challenging – up to 50 % of elderly patients with CKD in Alberta were not taking medications indicated to reduce cardiovascular risk and only 20 % of patients who meet referral criteria were seen by a kidney specialist [3]. Understanding this key gap, we sought the optimal knowledge translation (KT) intervention that would increase the uptake of guideline-concordant CKD care in clinical practice [4, 5]
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