RT Journal Article
SR Electronic
T1 Factors influencing practice variation in the management of nephrotic syndrome: a qualitative study of pediatric nephrology care providers
JF CMAJ Open
FD Canadian Medical Association
SP E424
OP E430
DO 10.9778/cmajo.20160078
VO 5
IS 2
A1 Susan M. Samuel
A1 Rachel Flynn
A1 Michael Zappitelli
A1 Allison Dart
A1 Rulan Parekh
A1 Maury Pinsk
A1 Cherry Mammen
A1 Andrew Wade
A1 Shannon D. Scott
A1 for the Canadian Childhood Nephrotic Syndrome Project Team*
YR 2017
UL http://www.cmajopen.ca/content/5/2/E424.abstract
AB Background: Treatment protocols for childhood nephrotic syndrome are highly variable between providers and care centres. We conducted a qualitative study to understand the complex multilevel processes that lead to practice variation and influence provider management of nephrotic syndrome.Methods: Focus groups with multidisciplinary pediatric nephrology care providers (n = 67) from 10 Canadian pediatric nephrology centres that had more than 1 pediatric nephrologist were conducted between September 2013 and April 2015. Focus group discussions were guided by the Ottawa Model for Research Use. We used a semistructured interview guide to elicit participants' perspectives regarding 1) the work setting and context of the clinical environment, 2) reasons for variation at the provider level and 3) clinical practice guidelines for nephrotic syndrome. Focus group discussions were transcribed and analyzed concurrently with the use of qualitative content analysis.Results: Emerging themes were grouped into 2 categories: centre-level factors and provider-level factors. At the centre level, the type of care model used, clinic structures and resources, and lack of communication and collaboration within and between Canadian centres influenced care variation. At the provider level, use of experiential knowledge versus empirical knowledge and interpretation of patient characteristics influenced provider management of nephrotic syndrome.Interpretation: Centre- and provider-level factors play an important role in shaping practice differences in the management of childhood nephrotic syndrome. Further research is needed to determine whether variation in care is associated with disparities in outcomes.