CHRONIC KIDNEY FAILURE AND CONSERVATIVE (NON-DIALYSIS) CARE AMONG OLDER ADULTS
Bibliographic record
Abstract
Conservative (non-dialysis) management of adults with stage 5 chronic kidney disease (CKD, eGFR <15ml/min/1.73m2) is increasingly being provided in the primary care setting. We aimed to examine the prevalence of barriers and facilitators to conservative management of older adults by primary care physicians. We conducted a cross-sectional population-based survey of all primary care physicians in Alberta, Canada. Eligible participants had experience caring for adults aged ≥75 years with stage 5 CKD not planning on initiating dialysis. Questionnaire items were derived from a qualitative descriptive study, informed by the Behavior Change Wheel, and tested for face and content validity. Physicians were contacted via postal mail and/or fax, based on a modified Dillman method. Four hundred and nine eligible physicians completed the questionnaire (9.6% response rate). The majority of respondents were male (61.6%), aged 40 to 60 years (62.6%), and practiced in a large/medium population centre (68.0%). The most common barrier to providing conservative care in the primary care setting was the inability to access support to maintain patients in the home setting (39.1% of respondents). The second most common barrier was working with non-physician providers with limited kidney-specific clinical expertise (32.3% of respondents). Primary care physicians indicated that the two most common strategies that would enhance their ability to provide conservative management would be the ability to use the telephone to contact a nephrologist or clinical staff (86.9% and 85.6% of respondents respectively). Important areas were identified to inform clinical programs for supporting primary care physicians’ provision of kidney conservative care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".