Abstract
BackgroundIn response to growing demand for urgent care services there is a need to implement more effective strategies in primary care to support patients with complex care needs. Improving primary care management of kidney health through the implementation of ‘sick day rules’ (i.e. temporary cessation of medicines) to prevent Acute Kidney Injury (AKI) has the potential to address a major patient safety issue and reduce unplanned hospital admissions. The aim of this study is to examine processes that may enable or constrain the implementation of ‘sick day rules’ for AKI prevention into routine care delivery in primary care.MethodsForty semi-structured interviews were conducted with patients with stage 3 chronic kidney disease and purposefully sampled, general practitioners, practice nurses and community pharmacists who either had, or had not, implemented a ‘sick day rule’. Normalisation Process Theory was used as a framework for data collection and analysis.ResultsParticipants tended to express initial enthusiasm for sick day rules to prevent AKI, which fitted with the delivery of comprehensive care. However, interest tended to diminish with consideration of factors influencing their implementation. These included engagement within and across services; consistency of clinical message; and resources available for implementation. Participants identified that supporting patients with multiple conditions, particularly with chronic heart failure, made tailoring initiatives complex.ConclusionsImplementation of AKI initiatives into routine practice requires appropriate resourcing as well as training support for both patients and clinicians tailored at a local level to support system redesign.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0480-5) contains supplementary material, which is available to authorized users.
Highlights
In response to growing demand for urgent care services there is a need to implement more effective strategies in primary care to support patients with complex care needs
Participants tended to express initial enthusiasm and understanding surrounding the rationale for sick day rules to prevent Acute Kidney Injury (AKI)
I’d use it with my patients who are identified as chronic kidney disease (CKD), who are on an ACE or an Angiotensin Receptor Blocker (ARB)...I don’t think there’s any reason not to give all of them this, the same way as you would a diabetic patient, you know, the sick day rules for their insulin ID04 (Practice Nurse)
Summary
In response to growing demand for urgent care services there is a need to implement more effective strategies in primary care to support patients with complex care needs. Improving primary care management of kidney health through the implementation of ‘sick day rules’ (i.e. temporary cessation of medicines) to prevent Acute Kidney Injury (AKI) has the potential to address a major patient safety issue and reduce unplanned hospital admissions. Acute Kidney Injury (AKI) is a major patient safety issue [1]. It is a clinical syndrome characterised by rapid reduction in kidney function [2]. AKI affects approximately 13.3 million people per year despite the fact that it is mostly preventable with timely intervention [3]. Optimal care including a focus on targeting interventions in primary care has the potential to save up to 12,000 lives per year and produce substantial savings for patients and the NHS [4, 8]
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