Primary Care Provider Perceptions of a Population Health Management Program to Improve Kidney Care: A Mixed Methods Study.

BACKGROUND

Primary care providers (PCPs) care for the majority of individuals with chronic kidney disease (CKD) but report multilevel barriers to CKD management. The Kidney Coordinated HeAlth Management Partnership (Kidney CHAMP) trial was a multidisciplinary population health management (PHM) intervention for nephrology co-management in the primary care setting.

OBJECTIVE

To obtain PCP perspectives on the Kidney CHAMP trial that will inform future system-wide implementation.

DESIGN

Mixed method study using surveys and phone interviews completed May 2021 to February 2022.

PARTICIPANTS

PCPs whose practice had at least 12 months of exposure to the intervention and had CKD patients who received the intervention.

INTERVENTIONS: The Kidney CHAMP intervention included nephrology electronic consult (e-consult) and pharmacist-led medication management, with recommendations directed to the PCP, and nurse-led CKD education for the patient.

APPROACH: Interview transcripts were inductively coded by two data analysts until thematic saturation was achieved, and thematic analysis was performed.

KEY

RESULTS

Twenty-nine PCPs completed the survey, and 23 PCPs were interviewed. Based on survey data, 90% of PCPs found the e-consult and pharmacist recommendations useful. Four major themes emerged from interviews: (1) PCPs favored e-consults because they addressed barriers to nephrology referral and provided easy specialty access; (2) PCPs valued the team-based approach of Kidney CHAMP; (3) PCPs felt that e-consult-based interventions may not be appropriate for all patients with CKD, and in some cases less impactful than face-to-face visits; and (4) some PCPs were dissatisfied with the burden of implementing recommendations and processing lengthy documentation.

CONCLUSIONS

An electronic health record-based PHM approach to increase timely access to nephrology care and multidisciplinary specialty team was viewed by PCPs as a valuable co-management intervention. Future improvements, including a more hands-on approach from the nephrology team to share the burden of implementation, and PCP workflow facilitation are potential opportunities to optimize the PHM intervention.