Implementation Barriers of Multidisciplinary Care in Chronic Kidney Disease Through a CFIR Framework: a Narrative Review

Abstract

Introduction 37 million Americans suffer from chronic kidney disease, which affects multiple organ systems and requires multidisciplinary care. Multidisciplinary care is an inherently broad and complex topic, and while it is being implemented across health care in the United States and abroad, multidisciplinary care outcomes are poor in this patient population. It is possible that there exist gaps in the literature regarding implementation and replication of multidisciplinary care interventions such that health care practices are unable to fully take advantage of multidisciplinary care publications for chronic kidney disease. This narrative review utilizes the five domains of the Consolidated Framework for Implementation Research to address barriers to multidisciplinary care implementation for chronic kidney disease. Methods A systematized review of peer-reviewed literature including systematic reviews and meta-analyses related to chronic kidney disease and multidisciplinary care through January 1, 2021 was conducted. The five interventions with the most barriers qualitatively identified were analyzed. Results Twelve potentially eligible reviews were identified, and 5 unique systematic reviews and meta-analyses were selected for a total of 48 articles, and ultimately, 5 articles were selected for inclusion. Based on the Consolidated Framework for Implementation Research which includes 5 domains of barriers, we discussed barriers of implementation in all 5 domains within the 5 articles. Discussion Because it is essential that multidisciplinary care for patients with chronic kidney disease be improved and implemented to the fullest extent, researchers should be aware of barriers to implementation and publish results by taking into account the Consolidated Framework for Implementation Research.