Abstract
BackgroundIn the UK, chronic disease, including chronic kidney disease (CKD) is largely managed in primary care. We developed a tool to assess practitioner confidence and knowledge in managing CKD compared to other chronic diseases. This questionnaire was part of a cluster randomised quality improvement interventions in chronic kidney disease (QICKD; ISRCTN56023731).MethodsThe questionnaire was developed by family physicians, primary care nurses, academics and renal specialists. We conducted three focus groups (n = 7, 6, and 8) to refine the questionnaire using groups of general practitioners, practice nurses and trainees in general practice. We used paper based versions to develop the questionnaire and online surveys to test it. Practitioners in a group of volunteer, trial practices received the questionnaire twice. We measured its reliability using Cohen’s Kappa (K).ResultsThe practitioners in the focus groups reached a consensus as to the key elements to include in the instrument. We achieved a 73.1% (n = 57/78) initial response rate for our questionnaire; of these 57, 54 completed the questionnaire a second time. Family physicians made up the largest single group of respondents (47.4%, n = 27). Initial response showed more female (64.9%, n = 37) than male (35.1%, n = 20) respondents. The reliability results from retesting showed that there was moderate agreement (k > 0.4) on all questions; with many showing substantial agreement (k > 0.6). There was substantial agreement in the questions about loop diuretics (k = 0.608, CI 0.432-0.784, p < 0.001), confidence in managing hypertension (k = 0.628, 95%CI 0.452-0.804, p < 0.001), diastolic blood pressure treatment thresholds in CKD (k = 0.608, 95%CI 0.436-0.780, p < 0.001) and the rate of decline of eGFR that would prompt referral (k = 0.764, 95%CI 0.603-0.925, p < 0.001).ConclusionThe QICKD-CCQ is a reliable instrument for measuring confidence and knowledge among primary care practitioners on CKD management in the context of UK primary care.
Highlights
In the UK, chronic disease, including chronic kidney disease (CKD) is largely managed in primary care
P4P was introduced for chronic disease management in primary care in 2004, and extended to include CKD in 2006 [8]
Whilst the response to P4P has been mixed [9,10,11], it is plausible that these P4P interventions might impact on renal replacement therapy, as P4P represents a form of quality improvement which could slow disease progression in CKD [12,13]
Summary
In the UK, chronic disease, including chronic kidney disease (CKD) is largely managed in primary care. We developed a tool to assess practitioner confidence and knowledge in managing CKD compared to other chronic diseases This questionnaire was part of a cluster randomised quality improvement interventions in chronic kidney disease (QICKD; ISRCTN56023731). The Quality Improvement in CKD trial (QICKD) [14] included a systematic review [12] and diagnostic analysis [15] to explore factors limiting achievement of quality improvement in CKD This revealed that primary care practitioners had gaps in their knowledge, highly variable views about this condition and lacked confidence in explaining and managing the condition [15,16]
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