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ePublished: 01 Jul 2014
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J Renal Inj Prev. 2014;3(3): 61-67.
doi: 10.12861/jrip.2014.20
PMID: 25340171
PMCID: PMC4206053
  Abstract View: 4992
  PDF Download: 2662

Review Article

Barriers to the successful practice of chronic kidney diseases at the primary health care level; a systematic review

Chaudhary Muhammad Junaid Nazar 1*, Tiffany Billmeier Kindratt 2, Syed Muhammad Ahtizaz Ahmad 3, Manzoor Ahmed 4, John Anderson 5

1 Department of Medicine, University of Buckingham, Ealing Hospital, NHS Trust, London, UK
2 Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, USA
3 Department of Community Medicine, Nawaz Sharif Medical College, Gujarat, Punjab, Pakistan
4 Department of Rural Health Development Program, Rural Area Development Council, Punjab, Pakistan
5 Division of Medical Education, Postgraduate Medicine Brighton & Sussex Medical School University of Brighton, Brighton, UK
*Corresponding Author: *Corresponding author: Chaudhary Muhammad Junaid Nazar,, Email: dr.cmjnazar@livd.co.uk

Abstract

Background: Chronic kidney disease (CKD), a major global public health problem, has been recognized as one of the eleven important causes of death. This review explores a wide range of barriers related to patients and health systems involved in controlling the prevalence of CKD at the primary health care level.Patients and Method: Electronic databases including PubMed/Medline, Cumulative Index to Nursing and Allied Health (CINAHL), Entrez, British Medical Journal (BMJ), EBSCO host, Cochrane and Google scholar were searched for the data published from 2000 to 2010 using MeSH terms such as ‘chronic kidney diseases’, ‘renal transplantation’, ‘complications’, ‘health care services’, ‘acute renal failure’. After screening 587 abstracts, a total of 10 studies were selected for systematic review. Developed countries such as the United Kingdom, the USA and other European countries were reviewed in order to identify the barriers associated with CKD practice at the primary health care level. The reasons for the failure of services at the primary health care level were categorized. A pre-defined protocol was used for data extraction and content appraisal.Results: At the primary health care level, the major barriers associated with CKD include the late referral of patients to nephrologists, old age, presence of several co-morbidities, lack of education and awareness among ethnic minorities, difficulty in communication between primary health care professionals, and the shortage of multi-disciplinary care team at dialysis centers. Additionally, factors such as drug-drug interaction during treatment, lack of anemia-management during dialysis, hypertension, and depression in CKD patients also act as important barriers in CKD care at the primary health care level.Conclusion: The knowledge and awareness about CKD management is lacking. Therefore, educational intervention is essential for patients as well medical personnel. Also, a multidisciplinary care team is essential for the complex management of CKD due to associated co-morbidities.

Implication for health policy/practice/research/medical education: Systematic review identified a wide range of barriers related to patients and health system involved in controlling the prevalence of CKD at the primary health care level. Lack of training and education of the primary health care is an important barrier for CKD and perhaps the most promising protective strategy for the government that can helps in early diagnosis of the kidney patients. Please cite this paper as: Junaid Nazar CM, Kindratt TB, Ahmad SMA, Ahmed M, Anderson J. Barriers to the successful practice of chronic kidney diseases at the primary health care level; a systematic review. J Renal Inj Prev 2014; 3(3): 61-67. DOI: 10.12861/jrip.2014.20
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