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Open Access Highly Accessed Research article

Development of a questionnaire to evaluate practitioners’ confidence and knowledge in primary care in managing chronic kidney disease

Mohammad Tahir12*, Simon Hassan12, Simon de Lusignan1, Lazza Shaheen2, Tom Chan1 and Olga Dmitrieva1

Author Affiliations

1 Department of Health Care Management and Policy, School of Management, University of Surrey, Guildford, Surrey GU2 7XH, UK

2 AT Medics, Edith Cavell Surgery, 41A-C Streatham High, London SW2 4TP, UK

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BMC Nephrology 2014, 15:73  doi:10.1186/1471-2369-15-73

Published: 7 May 2014

Abstract

Background

In the UK, chronic disease, including chronic kidney disease (CKD) is largely managed in primary care. We developed a tool to assess practitioner confidence and knowledge in managing CKD compared to other chronic diseases. This questionnaire was part of a cluster randomised quality improvement interventions in chronic kidney disease (QICKD; ISRCTN56023731).

Methods

The questionnaire was developed by family physicians, primary care nurses, academics and renal specialists. We conducted three focus groups (n = 7, 6, and 8) to refine the questionnaire using groups of general practitioners, practice nurses and trainees in general practice. We used paper based versions to develop the questionnaire and online surveys to test it. Practitioners in a group of volunteer, trial practices received the questionnaire twice. We measured its reliability using Cohen’s Kappa (K).

Results

The practitioners in the focus groups reached a consensus as to the key elements to include in the instrument. We achieved a 73.1% (n = 57/78) initial response rate for our questionnaire; of these 57, 54 completed the questionnaire a second time. Family physicians made up the largest single group of respondents (47.4%, n = 27). Initial response showed more female (64.9%, n = 37) than male (35.1%, n = 20) respondents. The reliability results from retesting showed that there was moderate agreement (k > 0.4) on all questions; with many showing substantial agreement (k > 0.6). There was substantial agreement in the questions about loop diuretics (k = 0.608, CI 0.432-0.784, p < 0.001), confidence in managing hypertension (k = 0.628, 95%CI 0.452-0.804, p < 0.001), diastolic blood pressure treatment thresholds in CKD (k = 0.608, 95%CI 0.436-0.780, p < 0.001) and the rate of decline of eGFR that would prompt referral (k = 0.764, 95%CI 0.603-0.925, p < 0.001).

Conclusion

The QICKD-CCQ is a reliable instrument for measuring confidence and knowledge among primary care practitioners on CKD management in the context of UK primary care.

Keywords:
CKD; Confidence; Kidney Failure; Chronic; Blood pressure; Primary Care; Questionnaire; Quality of Healthcare