Chronic kidney disease follow-up in primary healthcare

Abstract

Objective: To evaluate the efficiency and barriers linked to the management by primary care physicians (PCPs) of patients with chronic kidney disease (CKD). Method: Qualitative study based on a questionnaire self-applied to PCP in two cities of the state of São Paulo. The data were compared in an interview conducted with a secondary care nephrologist. Results: The data were gathered from 42 PCPs, from 28 basic healthcare units. Most of the respondentes were white, male, had graduated in Brazil and were aged between 26 and 64 years old. They had been in practice for 9,8 years on average, seeing < 10 patients with CKD per week. Their positive answers referred to diagnosis, health education and avoiding nephrotoxic agents. They reported having their own tools to avoid nephrotoxicity and to treat high blood pressure, but the majority (66,7%) do not follow any guideline for the management of CKD. Primary healthcare institutions do not provide educational resources for PCPs to monitor patients with CKD. The main elements obtained from secondary nephrological care indicate the following disagreements: early referral; schedule overload; loss in the counter- referral; absence of municipal protocols. Conclusion: For the management of patients with CKD, primary care professionals often use their own resources and demonstrate insecurity regarding specific aspects of the disease. Primary healthcare institutions neither offer tools nor supplies training for PCPs or establishes local protocols. Matrix-based support seems to be the most appropriate training strategy for this situation.