Additional File 1:
Questionnaire: How confident are General Practitioners & the Primary care team in managing Chronic Kidney Disease (CKD)
Description: (copy of confidence questionnaire used)
Number______
Comparing interventions to lower blood pressure in chronic kidney disease
Questionnaire: How confident are General Practitioners & the Primary care team in managing Chronic Kidney Disease (CKD)
This questionnaire is part of a multi-centre study that aims to test the effects of two quality improvement interventionsagainst usual practiceon the quality of management of CKD. The primary outcome measure of this study is the control of systolic blood pressure among patients with CKD.
Please complete all the questions. The questions ask about your confidence in management of patients with CKD. Some require you to select your personal threshold for intervention. The confidence questions are on a Likert Scale, with 1 representing ‘Not at all confident’, 2 ‘Not confident’, 3 ‘Neither confident nor not confident’, 4 ‘Confident’, 5 ‘Very confident’. Each section compares your confidence in practice in a clinical area using the Likert Scale above.
The information provided by you is strictly confidential. You or your practice will not be identified in any reports or publications that may result from this study.
1. Hypertension inpatients with CKD
Please circle the appropriate number on the 5-point scale: Not at all confident 1 , to Very confident 5 .
a.How confident are you at managing hypertension as a disease? / 1 / 2 / 3 / 4 / 5b. How confident are you at managing hypertension in patients with CKD? / 1 / 2 / 3 / 4 / 5
c. How confident are you at managing hypertension in patients with CKD / 1 / 2 / 3 / 4 / 5
with Diabetes (Type 2)?
d. How confident are you that you can achieve lowered blood pressure in / 1 / 2 / 3 / 4 / 5
patients with CKD?
e.What level of blood pressure control do you typically aim to achieve in patients with CKDwithout proteinuria? (Please tick one box in each column)
SystolicDiastolic
>160>90
151 - 16086 – 90
141 – 150 81 – 85
131 – 14076 – 80
121 - 13071 - 75
≤120≤70
Don’t knowDon’t know
2. eGFR- estimated Glomerular Filtration rate
Please circle the appropriate number on the 5-point scale: Not at all confident 1 , to Very confident 5 .
a. How confident are you at interpreting eGFR to stage CKD? / 1 / 2 / 3 / 4 / 5b. How confident are you with monitoring eGFR in patients with CKD? / 1 / 2 / 3 / 4 / 5
c. How confident are you at monitoring eGFR in CKD patient with Diabetes / 1 / 2 / 3 / 4 / 5
(Type 2)?
d. At what level of eGFR would you typically refer to secondary care?(Please tick one box)
eGFR >60 (Stage 1+2)
eGFR 45 – 59 (Stage 3A)
eGFR 30 – 44 (Stage 3B)
eGFR 15 – 29 (Stage 4)
eGFR <15 (Stage 5)
Don’t know
3. Proteinuria
Please circle the appropriate number on the 5-point scale: Not at all confident 1 , to Very confident 5 .
a. How confident are you at identifying significant proteinuria in patients / 1 / 2 / 3 / 4 / 5with Diabetes (Type 2)?
b. How confident are you at identifying significant proteinuria in patients / 1 / 2 / 3 / 4 / 5
with CKD?
c. How confident are you at using urine protein results to manage Diabetes / 1 / 2 / 3 / 4 / 5
(Type 2)?
d. How confident are you at using urine protein results to manage CKD? / 1 / 2 / 3 / 4 / 5
e. What level of blood pressure control do you typically aim to achieve in patients with CKDwith significant proteinuria?(Please tick one box in each column)
SystolicDiastolic
>160>90
151 - 16086 – 90
141 – 150 81 – 85
131 – 14076 – 80
121 - 13071 - 75
≤120≤70
Don’t knowDon’t know
4. Medications
Please circle the appropriate number on the 5-point scale: Not at all confident 1 , to Very confident 5 .
a. How confident are you in using ACE inhibitors and/or ARB (angiotensin II / 1 / 2 / 3 / 4 / 5receptor blockers)?
b. How confident are you in using ACE inhibitors and/or ARB inpatients / 1 / 2 / 3 / 4 / 5
with CKD?
c. How confident are you in using other anti-hypertensives in patients with / 1 / 2 / 3 / 4 / 5
CKD?
d. How confident are you in adding a loop diuretic drug (e.g. furosemide) / 1 / 2 / 3 / 4 / 5
to patients with CKD already on maximum dose of an ACE inhibitor and/or ARB?
5. Cardio-vascular disease (CVD) risk management and lifestyles
Please circle the appropriate number on the 5-point scale: Not at all confident 1 , to Very confident 5 .
a. How confident are you at identifying CVD risk factors for patients with / 1 / 2 / 3 / 4 / 5CKD?
b. How confident are you at assessing CVD risk scores in patients with / 1 / 2 / 3 / 4 / 5
Diabetes (Type 2)?
c. How confident are you at assessing CVD risk scores in patients with / 1 / 2 / 3 / 4 / 5
CKD?
d. How confident are you at initiating therapy to lower lipid levels in / 1 / 2 / 3 / 4 / 5
patients with ischaemic heart disease?
e. How confident are you at initiating therapy to lower lipid levels in / 1 / 2 / 3 / 4 / 5
patients with CKD?
6. Referrals to secondary care
Please circle the appropriate number on the 5-point scale: Not at all confident 1 , to Very confident 5 .
a. How confident are you at using referral guidelines to refer appropriate / 1 / 2 / 3 / 4 / 5patients with Diabetes (Type 2) to secondary care?
b. How confident are you at using referral guidelines to refer appropriate / 1 / 2 / 3 / 4 / 5
patients with CKD to secondary care?
c. What rate of decline per annum in eGFR would prompt you to refer to secondary care? (Please tick one box):
>5 ml/min/1.73m2 in 5 years
>5 ml/min/1.73m2 in 3 years
>5 ml/min/1.73m2 in 1 year
>3 ml/min/1.73m2 in 1 year
Not Known
7. Overall confidence in the management of Diabetes (Type 2) and CKD
Please circle the appropriate number on the 5-point scale: Not at all confident 1 , to Very confident 5 .
a. How confident are you in the overall management of patients with / 1 / 2 / 3 / 4 / 5Diabetes (Type 2)?
b. How confident are you in the overall management of patients with CKD? / 1 / 2 / 3 / 4 / 5
Please provide some information about yourself: -
The information provided by you is strictly confidential. You or your practice will not be identified in any reports/publications that will result from this study.
What is your role in the Practice (e.g. salaried GP, partner, practice nurse etc.): -
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What is your age band25-34 genderMale
35-44 Female
45-54
55-64
65+
Do you work: Full-time Part-time
Optional
If you wish to receive a copy of the survey finding for your individual practice, please stamp the details on your practice in the box:
Thank you for completing the questionnaire. Please use the FREEPOST addressed envelope to return the questionnaire to: -
Dr Aumran Tahir, GP Teaching Fellow, Department of General Practice and Primary Care
St. George's - University of London
This questionnaire is available for non commercial research provided its origin and reference are included in any publication.