236 IMPLICATIONS Our studies have implications for both practice and research. Below we describe these implications. Implications for practice We conducted our research in general practices and nephrology clinics, following the care for CKD patients in the Netherlands. GoyK reduced hypertension among those patients, especially in nephrology clinics, and improved the quality of consultations. In addition, when implemented, GoYK would save costs and lead to a reduction in deaths and new dialyses. Based upon these findings, we think broader implementation of GoYK in the Netherlands is promising. We expect broader implementation will build the competences of HCPs to support patients with LHL, while patients are better able to improve their self-management and to contribute to consultations, potentially leading to better clinical outcomes. Furthermore, we showed that, by focusing on health literacy, much is to be gained in the support of patients in earlier stages of CKD with the potential to prevent further kidney decline. HCPs experience barriers to explain the meaning of ‘having kidney disease’, and to support patients in their long-term selfmanagement. Considering the responsibility of general practices in the early identification of CKD and in the care for 1.5 million CKD patients, our results on these barriers hold important implications for them. General practitioners need to improve their information provision and support CKD patients, as well as those at risk for developing CKD, to better maintain changes in their self-management. This entails that general practitioners improve the early identification of patients with CKD. It is estimated that half of the patients with early stages of CKD are not diagnosed or not properly registered in the general practitioners’ electronic health systems[59]. Our results also uncover how patients experience multiple barriers in their self-management, and in retrieving information from consultations and from digital resources. In modern society, e-health and self-management are seen as important solutions for the growing health costs. Simultaneously, the time for consultations is reduced. Our findings indicate this to be at the disadvantage
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