Primary care physicians (PCPs) are often the first point of contact for individuals at risk of chronic kidney disease (CKD), including those with diabetes and hypertension. However, a significant obstacle in managing CKD progression and ensuring optimal patient care is the communication and coordination gap between PCPs and nephrologists. Addressing this critical issue is where the implementation of a Primary Care Foundation Audit Tool becomes invaluable.
A quality improvement study investigated the impact of tailored audit tools in nephrology and referring PCP practices. Conducted across nine PCP and five nephrology practices in Philadelphia and Chicago, the study utilized modified tools from the Renal Physicians Association toolkit. These tools were designed to enhance CKD identification, communication, and collaborative management between PCPs and nephrologists.
The study assessed various outcomes, including CKD identification rates, nephrologist referrals, communication effectiveness, and co-management processes. Data was collected through pre- and post-implementation interviews, questionnaires, site visits, monthly teleconferences, and chart audits. Qualitative analysis of interview transcripts helped understand practice patterns and perceptions.
The results demonstrated significant improvements across the board. PCPs enhanced their processes for CKD identification, nephrologist referrals, communication protocols, and the implementation of co-management plans. Notably, the documentation of glomerular filtration rate (GFR), a key indicator of kidney function, significantly increased (P=0.01). Nephrologists also reported improvements in referral and co-management processes. Post-intervention interviews revealed that PCPs had a heightened awareness of CKD risk factors, the necessity of tracking high-risk patients, and the importance of timely referrals. Similarly, nephrologists expressed increased focus on communication and co-management with PCPs, leading to greater satisfaction for all involved parties.
While the study’s limitations include the voluntary participation of nephrology practices and the non-statistical design of audit tools, the conclusions are compelling. The strategic use of customized audit tools effectively raised CKD awareness among PCPs, fostered better communication between practices, and improved co-management and cooperation between PCPs and nephrologists. This highlights the crucial role of primary care foundation audit tools in bridging gaps and optimizing CKD patient care within the primary care setting.
