Evidence map›Paper›PMID 30993634›Full record

ArticleJournal of general internal medicine2019

Primary Care Physicians' Perceived Barriers to Nephrology Referral and Co-management of Patients with CKD: a Qualitative Study.

Raquel C Greer, Yang Liu, Kerri Cavanaugh, Clarissa Jonas Diamantidis, Michelle M Estrella, C John Sperati, Sandeep Soman, Khaled Abdel-Kader, Varun Agrawal, Laura C Plantinga and 6 more

Abstract read
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In one paragraph

Article in Journal of general internal medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
51citing papers in PubMed, 2 pooled it
–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

51 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
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  15. Chronic Kidney Disease in Balkan Countries-A Call for Optimal Multidisciplinary Management.International journal of environmental research and public health · 2025
    Review
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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

16 authors.

Raquel C GreerThe Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA. rgreer@jhmi.edu.
Yang LiuThe Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA.
Kerri CavanaughVanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, USA.
Clarissa Jonas DiamantidisDivisions of General Internal Medicine and Nephrology, Duke University School of Medicine, Durham, NC, USA.
Michelle M EstrellaKidney Health Research Collaborative, Department of Medicine, Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco and San Francisco VA Health Care System, San Francisco, CA, USA.
C John SperatiDivision of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
Sandeep SomanDivision of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA.
Khaled Abdel-KaderVanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, USA.
Varun AgrawalDivision of Nephrology and Hypertension, University of Vermont, Burlington, VT, USA.
Laura C PlantingaDepartment of Medicine, Emory University, Atlanta, GA, USA.
Jane O SchellSection of Palliative Care and Medical Ethics, Renal-Electrolyte University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
James F SimonDepartment of Nephrology and Hypertension, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Joseph A VassalottiNational Kidney Foundation, New York, NY, USA.
Bernard G JaarThe Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA.
Michael J ChoiDivision of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
National Kidney Foundation Education Committee

Funding

Determining Key Organizational Health Communication Practices in Complex PatientsR01DK103935 · NIDDK · VANDERBILT UNIVERSITY MEDICAL CENTER · PI CAVANAUGH, KERRI · 2015 to 2019
$2.0M
Developing, Validating, and Implementing a CKD Predictive Model (DELVECKD)K23DK090304 · NIDDK · VANDERBILT UNIVERSITY MEDICAL CENTER · PI ABDEL-KADER, KHALED A · 2011 to 2015
$861k
Improving Primary Care to Narrow Racial Disparities in Chronic Kidney DiseaseK23DK094975 · NIDDK · JOHNS HOPKINS UNIVERSITY · PI GREER, RAQUEL CHARLES · 2012 to 2015
$722k
NIDDK NIH HHS K23 DK090304NIDDK NIH HHS K23 DK094975NIDDK NIH HHS R01 DK103935
6 · The paper itself

Abstract

backgroundEffective co-management of patients with chronic kidney disease (CKD) between primary care physicians (PCPs) and nephrologists is increasingly recognized as a key strategy to ensure the delivery of efficient and high-quality CKD care. However, the co-management of patients with CKD remains suboptimal.

objectiveWe aimed to identify PCPs' perceptions of key barriers and facilitators to effective co-management of patients with CKD at the PCP-nephrology interface. STUDY

designQualitative study SETTING AND

participantsCommunity-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC; and San Francisco, CA APPROACH: We conducted four focus groups of PCPs. Two members of the research team coded transcribed audio-recorded interviews and identified major themes. KEY

resultsMost of the 32 PCPs (59% internists and 41% family physicians) had been in practice for > 10 years (97%), spent ≥ 80% of their time in clinical care (94%), and practiced in private (69%) or multispecialty group practice (16%) settings. PCPs most commonly identified barriers to effective co-management of patients with CKD focused on difficulty developing working partnerships with nephrologists, including (1) lack of timely adequate information exchange (e.g., consult note not received or CKD care plan unclear); (2) unclear roles and responsibilities between PCPs and nephrologists; and (3) limited access to nephrologists (e.g., unable to obtain timely consultations or easily contact nephrologists with concerns). PCPs expressed a desire for "better communication tools" (e.g., shared electronic medical record) and clear CKD care plans to facilitate improved PCP-nephrology collaboration.

conclusionsInterventions facilitating timely adequate information exchange, clear delineation of roles and responsibilities between PCPs and nephrologists, and greater access to specialist advice may improve the co-management of patients with CKD.

Indexed as

Attitude of Health PersonnelQualitative ResearchAdultDisease ManagementFemaleHumansMaleMiddle AgedNephrologyPhysicians, Primary CareQuality of Health CareReferral and ConsultationRenal Insufficiency, Chronicchronic kidney diseaseco-managementnephrologyprimary carequalitative research

Identifiers

PMID30993634
PMCPMC6614220

What OpenQuestion holds

Textmetadata
Read underepoch 390

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 OpenQuestion graph.