Screening for chronic kidney disease in a hypertensive primary care cohort

Background: Screening rates for chronic kidney disease (CKD) in primary care settings remain low. Although primary care providers are well positioned to offer this testing, there are many barriers that contribute to low screening rates. Purpose: The purpose of this study was to examine both practice and contextual factors that relate to screening for CKD in a cohort of primary care patients with hypertension. Methods: A mixed-methods, single-embedded, convergent parallel design was used for this organizational case study. The Chronic Care Model served as the framework. Electronic medical record data, resource walk-through, and provider surveys were collected from selected primary care clinics within one large academic medical center in the Pacific Northwest. Analyses included regression models, descriptive statistics, narrative content analysis, and pattern matching for organizational case creation. Results: Screening rates were low in the cohort, but patients with more risk factors for CKD were more likely to receive orders for screening. Organizational and community support was deemed necessary for primary care providers to effectively translate guidelines into practice. Implications for practice: The results of this study offer support for a wholistic approach to guideline translation into practice. Participants in the study were open to increased screening for CKD but needed support in multiple ways from the organization. Guidelines alone were not deemed the ideal vehicles for translation of research into practice.