Patient Education for CKD and Decision Support in Primary Care: Findings From the EPIK Pilot Study

Abstract

Rationale & objective: Chronic kidney disease affects millions of people in the United States, yet effective interventions to address gaps in patient knowledge and engagement are not well established. We sought to develop and pilot a brief educational decision aid for patients with CKD cared for in primary care settings.

Study design: A pilot QI study of a decision aid intervention.

Setting & participants: The decision aid was introduced and used in one of two General Internal Medicine primary care clinics for adult patients with chronic kidney disease.

Quality improvement activities: Using QI methods, an EMR-based patient educational decision aid called the Encounter Decision Intervention (EDI) was developed with input from patients and clinicians for use during primary care visits to address a CKD diagnosis and engage patients in their clinical management.

Outcomes: Outcomes were assessed using validated surveys of perceived and objective CKD knowledge, CKD-specific stress and patient satisfaction were measured in both primary care clinics.

Analytical approach: Fisher exact tests, t-tests, and Kruskal-Wallis tests were used to detect univariable associations of outcomes with use of the EDI across primary care clinics.

Results: Seventy-four patients completed the study (37 in each clinic). There were no statistically significant differences in patient characteristics between clinics. The group treated in the clinic using the EDI had statistically significantly higher satisfaction with clinician communication, overall care, and with their clinicians. Patients reported high satisfaction with the EDI and clinicians reported favorable usability.

Limitations: A non-randomized comparison, small sample size, possible differences across practice settings.

Conclusion: A new integrated educational decision aid was successfully implemented in a primary care setting. Pilot testing suggested that the EDI was associated with higher patient satisfaction with clinician communication, overall care, and with their primary care provider.

Keywords: CKD; Education; Pilot Trial; Quality Improvement; Systems Engineering.