Guidelines or mindlines? - implementing a new CKD guideline in German primary care

• Published in: BMC family practice 2024-09, Vol.25 (1), p.344-8, Article 344
• Main Authors: Laker, Konrad, Bothe, Tim, Ebert, Natalie, Heintze, Christoph, Schaeffner, Elke, Krüger, Karen
• Format: Article
• Language: English
• Subjects: Adult; Analysis; Attitude of Health Personnel; Care and treatment; Chronic kidney failure; CKD; Clinical medicine; Data collection; Decision making; Female; General Practitioners; Germany; Guideline Adherence; Guidelines; Humans; Implementation; Insurance claims; Interviews; Interviews as Topic; Kidney diseases; Laws, regulations and rules; Male; Medical referrals; Methods; Middle Aged; Mindlines; Mortality; Nephrology; Physicians; Practice guidelines (Medicine); Practice Guidelines as Topic; Practice Patterns, Physicians' - standards; Primary care; Primary Health Care; Qualitative Research; Quality improvement; Renal Insufficiency, Chronic - therapy
• ISSN: 2731-4553; 2731-4553; 1471-2296
• DOI: 10.1186/s12875-024-02589-w

The development of clinical guidelines aimed at GPs is a key strategy to improving the management of chronic kidney disease (CKD). In 2019, the first CKD guideline aimed specifically at GPs practicing in Germany was published by the German College of General Practitioners and Family Physicians (DEGAM.) AIMS: The aim of this study is to identify the barriers and enablers for the implementation of this guideline. The results of this project, together with quantitative evaluation against quality indicators for CKD in primary care will inform an update to the guideline. We performed 17 semi-structured interviews with GPs practicing in Berlin and Brandenburg. Transcripts were analysed using qualitative content analysis as described by Mayring. We found that the perception of low clinical priority of CKD compared to other chronic diseases, opportunity cost of using guidelines, as well as poor patient understanding were significant barriers. GPs expressed that improved graphic design or integration of guideline recommendations in clinical decision support systems were enabling factors. Clinical problems concerning CKD were mostly solved by recourse to informal communication with specialists. GPs reported that they rarely consulted CKD guidelines as an aide to clinical decision making. The most significant barrier to use was that guidelines were not used as step-by-step decision aide in consultations with patients. Our analysis suggests that informal contact between primary and secondary care is significant conduit for evidence-based information on CKD in German primary care. Implementation projects should support the development of these relationships.