The majority of surveyed primary care physicians report using guidelines from the American Diabetes Association (79%) and Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (78%) in treating CKD; but only 22% reported using the CKD-specific National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines.
Chart Explanation: Nearly 80% of primary care physicians are familiar with and influenced by the American Diabetes Association and Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure guidelines for treatment of CKD. However, only about one in five primary care physicians (22%) used the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, although it should be noted that these guidelines were published in 2002, only 1 year before the survey was conducted.
In 2003, the National Kidney Disease Education Program (NKDEP) conducted a telephone survey of 464 primary care physicians in six primarily African-American communities (Atlanta, GA; Baltimore, MD; Cleveland, OH; New Orleans, LA, St. Louis, MO; Memphis, TN). Due to inclusion criteria, the participants may not respresent the average primary care physician in terms of patient population or level of CKD knowledge.
The 2003 NKDEP physician survey of 464 primary care physicians (7.6% response rate) in six primarily African-American communities (Atlanta, GA; Baltimore, MD; Cleveland, OH; New Orleans, LA, St. Louis, MO; Memphis, TN) (Lea, McClellan, Melcher, Gladstone, & Hostetter, 2006) included physicians identifying family practice, general practice, or general internal medicine as their specialty and patient populations that were at least 20% diabetic and/or hypertensive. The survey consisted of asking the physician: “Please indicate how much you believe the following risk factors increases a patient’s risk for CKD, ie, CKD or chronic renal insufficiency?,” with possible responses of “does not increase risk,” “slightly increases risk,” “moderately increases risk,” or “greatly increases risk.” Risk factors included African-American race/ethnicity, family history, diabetes mellitus, and hypertension. Additionally, physicians were asked: “Of the following guidelines, which have influenced your practices and procedures for treatment of CKD?,” with possible responses of “yes” or “no” to guidelines including the American Diabetes Association (ADA) Position Statement on Nephropathy, the Sixth Joint National Committee Report (JNC-VI), and the Kidney Disease Outcomes Quality Initiative (KDOQI).
|Description of Measure||Knowledge of CKD risk factors among primary care physicians|
|Data Source||National Kidney Disease Education Program|
|Type of Data Source||Private|
|Data Set||Survey results|
|Health Care System Data||No|
|Regional or National?||Regional|
|Demographic Group||Primary care physicians (family practitioner, general practitioner, or general internal medicine specialist) with ≥20% diabetic and/or hypertensive patients|
|Numerator||Responding physicians indicating risk factor as increasing CKD risk for patients|
|Denominator||All responding physicians|
|Primary Data Source Indicator||Proportion of physicians surveyed who identified risk factor as “moderately” or “greatly” increasing CKD risk|
|Primary Indicator Method of Measurement||Survey (office telephone survey)|
|Frequency of Measurement (Primary)||Once (cross-sectional)|
|U.S. Region Covered by Primary Variable||6 predominantly African-American communities (Atlanta, GA; Baltimore, MD; Cleveland, OH; New Orleans, LA, St. Louis, MO; Memphis, TN)|
|Period Currently Available||2003|
|Additional Data Items of Interest||Knowledge of clinical guidelines|
|Limitations of Indicator||Urban physicians only in predominantly African-American communities; low response rate (7.6%), limiting generalizability|
|Analytical Considerations||Categories lumped due to small groups/missing responses|
References and Sources:
Lea JP, McClellan WM, Melcher C, Gladstone E, Hostetter T. CKD risk factors reported by primary care physicians: do guidelines make a difference? Am J Kidney Dis. 2006;47(1):72-7.