Evidence map›Paper›PMID 38834994›Full record

ArticleBMC primary care2024

Primary care clinician perspectives on automated nephrology e-consults for diabetic kidney disease: a pre-implementation qualitative study.

Chi D Chu, Daniel Dohan, Michelle M Estrella, Michael G Shlipak, Delphine S Tuot

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In one paragraph

Article in BMC primary care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Chi D ChuDepartment of Medicine, University of California, San Francisco, San Francisco, CA, 94110, USA. Chi.Chu@ucsf.edu.
Daniel DohanPhilip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.
Michelle M EstrellaDepartment of Medicine, University of California, San Francisco, San Francisco, CA, 94110, USA.
Michael G ShlipakDepartment of Medicine, University of California, San Francisco, San Francisco, CA, 94110, USA.
Delphine S TuotDepartment of Medicine, University of California, San Francisco, San Francisco, CA, 94110, USA.

Funding

NIA NIH HHS K07AG066814NIDDK NIH HHS K23 DK131316NIDDK NIH HHS K23 DK131316-01A1
6 · The paper itself

Abstract

backgroundMany patients with diabetic kidney disease (DKD) do not receive evidence-based, guideline-recommended treatment shown to reduce DKD progression and complications. Proactive electronic consultations (e-consults) are an emerging intervention strategy that could potentially allow nephrologists to provide timely and evidence-based guidance to primary care providers (PCPs) engaged in early DKD care.

methodsThe objective of this study was to explore perspectives about potential barriers and facilitators associated with a proactive e-consult program to improve DKD care delivery. We conducted semi-structured qualitative interviews with PCPs across three different health systems. Interview transcripts were reviewed in a rapid qualitative analysis approach to iteratively identify, refine, and achieve consensus on a final list of themes and subthemes.

resultsA total of 18 interviews were conducted. PCPs across all sites identified similar challenges to delivering guideline-recommended DKD care. PCPs were supportive of the proactive e-consult concept. Three major themes emerged surrounding (1) perceived potential benefits of proactive e-consults, including educational value and improved specialist access; (2) concerns about the proactive nature of e-consults, including the potential to increase PCP workload and the possibility that e-consults could be seen as documenting substandard care; and (3) leveraging of care teams to facilitate recommended DKD care, such as engaging clinic-based pharmacists to implement specialist recommendations from e-consults.

conclusionIn this pre-implementation qualitative study, PCPs noted potential benefits and identified concerns and implementation barriers for proactive e-consults for DKD care. Strategies that emerged for promoting successful implementation included involving clinic support staff to enact e-consult recommendations and framing e-consults as a system improvement effort to avoid judgmental associations.

Indexed as

Attitude of Health PersonnelDiabetic NephropathiesPhysicians, Primary CareQualitative ResearchFemaleHumansInterviews as TopicMaleNephrologyPrimary Health CareRemote ConsultationChronic kidney diseaseDiabetic kidney diseaseE-consultsElectronic consultationNephrology referral

Identifiers

PMID38834994
PMCPMC11149280

What Socratic holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.