Perceptions and use of the national kidney foundation KDOQI guidelines: a survey of U.S. renal healthcare providers

Abstract

BackgroundThe National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) developed guidelines to care for patients with chronic kidney disease (CKD). While these are disseminated through the NKF’s website and publications, the guidelines’ usage remains suboptimal. The KDOQI Educational Committee was formed to identify barriers to guideline implementation, determine provider and patient educational needs and develop tools to improve care of patients with CKD.MethodsAn online survey was conducted from May to September 2010 to evaluate renal providers’ familiarity, current use of and attitudes toward the guidelines and tools to implement the guidelines.ResultsMost responders reported using the guidelines often and felt that they could be easily implemented into clinical practice; however, approximately one-half identified at least one barrier. Physicians and physician extenders most commonly cited the lack of evidence supporting KDOQI guidelines while allied health professionals most commonly listed patient non-adherence, unrealistic guideline goals and provider time-constraints. Providers thought that the guidelines included too much detail and identified the lack of a quick resource as a barrier to clinical implementation. Most were unaware of the Clinical Action Plans.ConclusionsPerceived barriers differed between renal clinicians and allied health professionals; educational and implementation tools tailored for different providers are needed.

Pragmatic Clinical Trials in CKD: Opportunities and Challenges

“…This helps translate research results to clinical care, lowering well known barriers to the implementation of existing practice guidelines for care of patients with CKD. 27,28 The majority of CKD patients are cared for by primary care providers with or without collaboration with nephrologists, 8,29 and PCTs may be well positioned to affect CKD care in the primary care setting. Examples of studies bridging nephrology and primary care include trials of CKD care coordination with patient navigators 30 and strategies to implement guidelineconcordant CKD care with electronic checklists, 31 primary care practice facilitation, 32 and pharmacist-led interventions.…”

CKD for Primary Care Practitioners: Can We Cut to the Chase Without Too Many Shortcuts?

“…However, a lack of evidence base had been cited as the most common barrier to guideline implementation among nephrology care practitioners. 5 Subsequent clinical trial and cohort data led to the KDIGO (Kidney Disease: Improving Global Outcomes) clinical practice guideline for the evaluation and management of CKD, which was published in 2013. 6 The KDIGO document provided a detailed rationale for recommendations and suggestions to address areas of controversy among nephrologists, such as diagnostic criteria for CKD in the elderly.…”

Implementing an evidence-based clinical decision support tool to improve the detection, evaluation, and referral patterns of adult chronic kidney disease patients in primary care

“…Barriers to implementation of KDOQI guidelines include provider perception of outdated guidelines, lack of integration into practice, and provider time constraints. Additionally, approximately one third of providers perceive there is a lack of evidence supporting KDOQI guidelines (Estrella et al., ). The majority of providers favor electronic support to assist with CKD patients (Abdel‐Kader et al., ).…”

“…The evidence suggests implementation of clinical support tools to improve awareness and increase the access and utilization of the NKF‐KDOQI guidelines (Estrella et al., ). QIs to increase CKD awareness and knowledge have been effective (Fox et al., ; Thompson‐Martin et al., ).…”