79 Theme 2: Lacking effective strategies Common strategies applied by HCPs from all settings, such as education or motivational interviewing, did not always lead to change. GPs mentioned how consultations often were about multiple other topics, such as diabetes or metabolic syndrome, and not about CKD. Nephrology specialists were uncertain on whether they explained kidney functioning or lab results in too much detail. Physicians from both settings indicated they gave priority to medical issues rather than discussing lifestyle. If strategies were ineffective, HCPs struggled in applying person-centred strategies. For example, they found it difficult to determine if patients needed practical guidance, strong confrontation or a comforting style to improve self-management. HCPs knew effective strategies, such as asking patients to repeat information, but felt untrained or reluctant to apply them. Theme 3: Health care barriers HCPs mentioned various health care barriers that potentially disadvantage patients with LHL. They thought cooperation between GPs and nephrology specialists, or within a care team, needed improvement. GPs, for example, struggled to determine when kidney problems needed discussion. Better collaboration with nephrology specialists could improve their support of CKD patients. Within hospital nephrology teams, members sometimes gave different health advices to one patient, causing confusion. All HCPs believed this is more disadvantageous for patients with LHL, who have problems to seek clarification if information is absent or contradictory. HCPs mentioned to lack time during consultations. As a result, they used most time to inform about the medical condition, instead of teaching about selfmanagement. HCPs considered this a risk for patients with LHL, who have more problems to self-manage effectively. Last, HCPs feared decreased accessibility of health services. Costs for medications, physiotherapy and dieticians are rising, causing problems for patients with LHL, who often have lower incomes.
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