Chronic kidney disease (CKD) is growing population health concern worldwide, and with early identification and effective management, kidney disease progression can be slowed or prevented. Most patients with risk factors for chronic kidney disease are treated within primary healthcare. Therefore, it is important to understand how best to support primary care providers (PC-P) to detect and manage chronic kidney disease. The aim of this systematic review was to evaluate barriers and enablers to the diagnosis and management of CKD in primary care. A systematic review of qualitative research on the barriers and/or enablers to detection and/or management of CKD in adults within primary healthcare was conducted. The databases Medline (EBSCO), PubMed, Cochrane CENTRAL, CINAHL (EBSCO) and Joanna Briggs Institute Evidence Based Practice (Ovid) were searched until 27th August 2019. Barriers and/or enablers reported in each study were identified, classified into themes, and categorised according to the Theoretical Domains Framework. A total of 20 studies were included in this review. The most commonly reported barriers related to detection and management of CKD in primary care were categorised into the ‘Environmental context and resources’ domain (n = 16 studies). Overall, the most common barrier identified was a lack of time (n = 13 studies), followed by a fear of delivering a diagnosis of CKD, and dissatisfaction with CKD guidelines (both n = 10 studies). Overall, the most common enabler identified was the presence of supportive technology to identify and manage CKD (n = 7 studies), followed by the presence of a collaborative relationship between members of the healthcare team (n = 5 studies). This systematic review identified a number of barriers and enablers which PC-P face when identifying and managing CKD. The findings of this review suggest a need for time-efficient strategies that promote collaboration between members of the healthcare team, and practice guidelines which consider the frequently co-morbid nature of CKD. Enhanced collaboration between PC-P and nephrology services may also support PC-Ps when diagnosing CKD in primary care, and facilitate improved patient self-management.

中文翻译：

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在初级卫生保健中检测和管理慢性肾脏病的障碍和促成因素：系统评价。

慢性肾脏病（CKD）在全球范围内日益引起人们的健康关注，并且通过早期发现和有效管理，可以减缓或预防肾脏疾病的进展。大多数具有慢性肾脏疾病危险因素的患者均在基本医疗保健中接受治疗。因此，重要的是要了解如何最好地支持初级保健提供者（PC-P）检测和管理慢性肾脏病。这项系统评价的目的是评估初级保健中CKD诊断和管理的障碍和促成因素。对初级保健中成人检测和/或治疗CKD的障碍和/或促成因素的定性研究进行了系统的综述。数据库Medline（EBSCO），PubMed，Cochrane CENTRAL，搜索CINAHL（EBSCO）和乔安娜·布里格斯研究所的循证实践（Ovid），直到2019年8月27日。确定每个研究报告的障碍和/或推动因素，将其分类为主题，并根据理论领域框架进行分类。该评价共纳入20项研究。与基层医疗中CKD的检测和管理有关的最常报告的障碍归为“环境和资源”领域（n = 16项研究）。总体而言，确定的最常见障碍是时间不足（n = 13项研究），其次是担心无法诊断出CKD，并且对CKD指南不满意（n = 10项研究）。总体而言，确定的最常见促成因素是用于识别和管理CKD的支持技术（n = 7个研究），其次是医疗团队成员之间的协作关系（n = 5个研究）。这项系统的审查确定了PC-P在识别和管理CKD时面临的许多障碍和促成因素。这项审查的结果表明，需要一种节省时间的策略来促进医疗团队成员之间的协作，并需要考虑到CKD经常合并症的实践指南。诊断初级保健中的CKD时，PC-P和肾脏病服务之间增强的协作也可能支持PC-P，并有助于改善患者的自我管理。这项审查的结果表明，需要一种节省时间的策略来促进医疗团队成员之间的协作，并需要考虑到CKD经常合并症的实践指南。诊断初级保健中的CKD时，PC-P和肾脏病服务之间增强的协作也可能支持PC-P，并有助于改善患者的自我管理。这项审查的结果表明，需要一种节省时间的策略来促进医疗团队成员之间的协作，并需要考虑到CKD经常合并症的实践指南。诊断初级保健中的CKD时，PC-P和肾脏病服务之间增强的协作也可能支持PC-P，并有助于改善患者的自我管理。