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Acute Kidney Injury Survivor Care Following Hospital Discharge: A Mixed-Methods Study of Nephrologists and Primary Care ProvidersPlain-Language Summary
oleh: Heather P. May, Abby K. Krauter, Dawn M. Finnie, Rozalina G. McCoy, Kianoush B. Kashani, Joan M. Griffin, Erin F. Barreto, Joe Herges, PharmD, Andrea Kattah, MD, MSc, Brenda Anderson, RN, Angeliki Tinaglia, RRT, LRT, Lauri Meade, RN
| Format: | Article |
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| Diterbitkan: | Elsevier 2023-04-01 |
Deskripsi
Rationale & Objective: Widespread delivery of high-quality care for acute kidney injury (AKI) survivors after hospital discharge requires a multidisciplinary team. We aimed to compare management approaches between nephrologists and primary care providers (PCPs) and explored strategies to optimize collaboration. Study Design: Explanatory sequential mixed-methods study using a case-based survey followed by semi-structured interviews. Setting & Participants: Nephrologists and PCPs providing AKI survivor care at 3 Mayo Clinic sites and the Mayo Clinic Health System were included. Outcomes: Survey questions and interviews elucidated participants’ recommendations for post-AKI care. Analytical Approach: Descriptive statistics were used to summarize survey responses. Qualitative data analysis used deductive and inductive strategies. A connecting and merging approach was used for mixed-methods data integration. Results: 148 of 774 (19%) providers submitted survey responses (24/72 nephrologists and 105/705 PCPs). Nephrologists and PCPs recommended laboratory monitoring and follow-up with a PCP shortly after hospital discharge. Both indicated that the need for nephrology referral, and its timing should be dictated by clinical and non-clinical patient-specific factors. There were opportunities for improvement in medication and comorbid condition management in both groups. Incorporation of multidisciplinary specialists (eg, pharmacists) was recommended to expand knowledge, optimize patient-centered care, and alleviate provider workload. Limitations: Survey findings may have been affected by non-response bias and the unique challenges facing clinicians and health systems during the COVID-19 pandemic. Participants were from a single health system, and their views or experiences may differ from those in other health systems or serving different populations. Conclusions: A multidisciplinary team-based model of post-AKI care may facilitate implementation of a patient-centered care plan, improve adherence to best practices, and reduce clinician and patient burden. Individualizing care for AKI survivors based on clinical and non-clinical patient-specific factors is needed to optimize outcomes for patients and health systems.