83 Theme 3: Health care barriers CKD not a topic in GPs Male, 61 years, general practitioner (FGD): ‘I am thinking, but during my whole career, I never said to a patient you have a kidney disease, despite the fact that there are dozens of people with reduced kidney function. I just stick to there are some proteins in your urine.’ Less time for consultations Female, 39 years, specialized nurse nephrology (FGD): ‘You can’t do everything in 20 minutes. So, you have to feel a bit if you need to do something at that moment with that patient or not. I don’t think you need to ask and discuss this [integrating self-management in the patient’s life] with every patient but with some you should.’ Decreasing accessibility to health services Female, 39 years, nephrologist (FGD): ‘I recently had a patient who said I am not going to the dietician and I can also not go to the physiotherapist because the insurance just doesn’t cover it. And yes, I also couldn’t think of anything. I understand that patients make these decisions out of financial considerations and there is nothing I can do about it.’ Professional cooperation Female, 55 years, specialized GP nurse (INT): ‘I think it’s important that when a patient sees several different professionals, that they all say the same. Because, for the patient it is very confusing if the dietician says: ‘You shouldn’t eat raw fish!’, and the doctor says, “Well, if you take some salmon once in a while, that’s not bad.’ We should try to express the same vision. But I think it’s not always done at the moment.’ FGD = participant of focus group discussion, INT = participant of interview Table 3.2 Continued
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