Primary Care Physicians' Practices and Barriers in Evaluating and Managing Chronic Kidney Disease in New Providence, The Bahamas

ObjectivesTo assess the practices and barriers in evaluating and managing chronic kidney disease among primary care physicians in New Providence, The Bahamas. MethodsA cross-sectional study utilizing an anonymous, self-administered questionnaire was given to General Practitioners, Family Medicine, and Internal Medicine physicians after using a simple random sampling approach. Descriptive and inferential statistical analysis was conducted using IBM SPSS software. ResultsThere were 119 physicians in this study with Family Medicine specialty area representing 52.1%. Seventy-four (74) physicians reported following CKD guidelines. The most common at-risk groups identified were Diabetes Mellitus (100%), Hypertension (98.3%), and use of nephrotoxic agents (97.5%). The most common diagnostic test used to identify CKD was eGFR (97.5%) and 72.2% of physicians used eGFR alone to stage CKD. Physicians overall agreed (40.3 - 50.4%) they were comfortable in diagnosing and managing CKD and its complications except for bone disorders (43.2%) and metabolic acidosis (34.7%) where responses were neutral. Physicians were neutral in having tools/resources to help them manage bone disorders (35.3%) and metabolic acidosis (31.9%) and disagreed to having educational tools for patients to understand bone disorders (32.2%) and metabolic acidosis (32.8%). Physicians agreed-strongly agreed with 12 of 13 perceived barriers, and there were 26 unique barriers expressed (8 patient-level, 7 provider-level, 11 systems-level). ConclusionsDeficits in the evaluation and management of CKD, and numerous barriers to CKD care were discovered. Recommendations include the development of a national CKD guideline, local CKD continuous medical education seminars, and public health campaigns on CKD education.