IMPROVING POST-ACUTE KIDNEY INJURY (AKI) CARE IN THE PRIMARY CARE SETTING: AN IMPLEMENTATION STUDY

Acute Kidney Injury (AKI)-related hospitalizations are associated with short- and long-term health consequences, but post-AKI management and monitoring in the outpatient primary care setting are suboptimal. We conducted a qualitative study to identify barriers to optimal post-AKI follow-up in British Columbia, Canada. We then applied this information to develop an intervention package with the goal of improving care transition after hospital discharge in patients experiencing AKI.

Guided by the Theoretical Domains Framework, we conducted 2 focus groups with interest holders, including multidisciplinary health care providers (family medicine, nephrologists, pharmacists, nurse practitioners), patient partners, and caregivers from various health regions in British Columbia, Canada. Our questions focused on AKI knowledge, beliefs about capabilities, beliefs about consequences, professional role, environmental context and resources, and current barriers/gaps in care. Focus group sessions were transcribed. Two research team members independently identified codes and categorized them into themes. We then mapped the data from the focus groups with the Capability, Opportunity, Motivation - Behavior (COM-B) Model for Behaviour Change to develop implementation strategies. All implementation tools and educational materials were reviewed by multidisciplinary focus groups.

In our focus groups, patient perspectives identified difficulties with being able to comprehend the consequences of AKI at the time of discharge. Patients mentioned they tend to depend on their family members for assistance. They also indicated the importance of having self-management resources they could review after discharge. Primary care providers described the quality of current hospital discharge summaries as variable. No formal system existed to consistently flag or follow patients with AKI after hospital discharge, despite repeated concerns raised by nephrology clinicians about preventable complications and missed opportunities for early intervention. Follow-up plans, including identification of providers responsible for follow-up and medication management, were often unclear. Overall gaps included a lack of patient education resources, and insufficient details regarding AKI and follow up plans in the hospital discharge summary.

Based on our findings, we selected implementation strategies focused on educating and modeling behavior. We developed an AKI pathway that includes an AKI-specific discharge template integrated into the hospital electronic health record systems, supported by local nephrologist champions; patient-facing education (website and AKI handout); and physician-facing education (website, webinar, and a post-AKI medication management guide).

This foundational work provided critical insights into workflow barriers, communication breakdowns, and knowledge gaps across the care continuum, which helped to inform co-design of a post-AKI care pathway, including targeted educational interventions for patients and providers, tailored to our regional context. A feasibility study that aims to evaluate the implementation of our multi-pronged intervention to improve follow-up care after AKI hospitalization is currently underway.