e P4P) for patients with diabetes or hypertension. These tests must be performed annually by general practitioners (GPs), but are not sufficiently performed, although drug therapies depend on them. We wanted to understand the practice of urinary protein screening assays by means of a qualitative study on the experience of GPs in a French region, with a view to developing facilitating strategies. Methods: This qualitative, semiopragmatic, phenomenological study analyzed in-depth interviews held with a purposive sample (age, gender, training, type of practice, rural/urban context) of 27 general practitioners, with triangulation of researchers until data saturation. Results: GPs recognized the assay as a systematic screening tool in accordance with the guidelines, but limited it to patients with diabetes or hypertension encouraged by P4P. Noting that their intervention was limited to kidney-protective measures already in place and, unaware of the new drugs, they saw no benefits and considered it a non-priority test. The existence of several urinary assays with varying intervention thresholds, changes in guidelines and the fact that specialists in laboratory medicine can decide which test to use depending on reimbursement by the health insurance scheme, all contributed to GPs' confusion in prescribing and interpreting tests. One consequence of this was inappropriate referral to the nephrologist. These tests required them to adopt a patient-centered educational approach, making it difficult for certain patients to perform them. Conclusion: GPs were aware of guideline recommendations to screen for albuminuria in patients with diabetes and hypertension but had difficulty interpreting the results. Their lack of perceived clinical consequences and new drugs should be targeted to improve the situation. Copyright © 2024 by the American Society of Nephrology...

中文翻译：

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基于初级保健视角的白蛋白尿检测的障碍和机遇：一项定性研究


e P4P） 用于糖尿病或高血压患者。这些测试必须由全科医生 （GP） 每年进行一次，但尽管药物治疗依赖于他们，但这些测试并未得到充分执行。我们想通过对法国地区 GP 经验的定性研究来了解尿蛋白筛查分析的实践，以期制定促进策略。方法：这项定性、符号语用、现象学研究分析了对 27 名全科医生的有目的的样本（年龄、性别、培训、实践类型、农村/城市背景）进行的深入访谈，并对研究人员进行三角测量，直到数据饱和。结果： 全科医生根据指南将该检测视为一种系统性筛查工具，但仅限于受 P4P 鼓励的糖尿病或高血压患者。他们注意到他们的干预仅限于已经实施的肾脏保护措施，并且不知道这些新药，他们看不到任何好处，并认为这是一项非优先测试。存在几种具有不同干预阈值的尿液检测方法、指南的变化以及实验室医学专家可以根据健康保险计划的报销来决定使用哪种检测的事实，都导致了全科医生在开具和解释检测结果时的混乱。这样做的一个后果是不恰当地转诊给肾病学家。这些测试要求他们采用以患者为中心的教育方法，这使得某些患者难以执行。结论： 全科医生知道指南建议筛查糖尿病和高血压患者的白蛋白尿，但难以解释结果。 他们缺乏感知到的临床后果和新药应该有针对性地改善这种情况。美国肾脏病学会版权所有 © 2024...