Table 2 Main themes identified from individual interviews

 Enhanced communication between primary care physician and specialist (nephrologist) and/or specialist clinic

Facilitator

“…not creating a way that our specialist colleagues tell us what they think we should be doing. But rather how can they help us, how can they help us improve, recognizing that we don’t have the same resources, etc.” (PCP03)

 Enhanced communication between primary care team members (multidisciplinary team, residents)

Facilitator

“We have access to other health care practitioners, we have educators, we have specialists that are linked to our primary care network. So this will compliment that” (PCP08)

“Try to maintain continuity with a lot of our patients who see our residents…good for them so the patient knows what we’re testing and things like that” (PCP02)

 Enhanced communication between primary care physician/professional and patient

Facilitator

“Augment patient explanations… visuals good for patients to reinforce information……validates our plan to them (patient)” (PCP02)

“Some sort of handout for patients on what sort of meds they can be on” (PHARM01) “Part of our problem as specialists is we don’t clarify or make it (CKD care) very clear to patients” (NEPH01)

 Consistency in information provided

Facilitator

“We should all get on the same page… I love the fact that they’ve chosen to do eGFRs” (PCP03) “every physician is different, but this is one resource we can turn to for consistency purposes for my practice” (N02)

 Inability to do electronic referral (eReferral) from within tool

Barrier

“eReferral – link EMR and referral – forces you to put the right pieces in” (PCP03)

 Point-of-care tool, with single access point

Facilitator

“It’s very quick to decide if someone has CKD, it reminds me about the things I have to do…” (PCP01) “Great to have all that information in one place” (PCP03) “Easy to quickly run through it when you’re in between patients or on a visit if you want to confirm that your management is correct” (PCP07)

 Team members can use tool which assists with clinic workflow

Facilitator

“Before I see a patient my medical office assistant just clicks”(PCP08)

“Chronic disease nurse using the CKD pathway – think that would be brilliant” (PCP06)

 Technical issues with browser version

Barrier

“It is a great resource and it’s a shame that we cannot access it” (N02)

 Inability to link directly to EMR

Barrier

“Hoping that this CKD pathway is to be part of our EMR” (PCP08)

 Viewed as credible site

Facilitator

“Can be comfortable saying…. from a position of knowledge” (PCP03)

 Provides knowledge and training for CKD

Facilitator

“Demonstrating CKD information to student/clerks/residents - it gives them confidence” (PCP07)

 Facilitates behavior change

Facilitator

“it (tool) encourages me not to screen as broadly as I was screening” (PCP04)

“comfort level did not have before, it’s like a tool for identifying patients” (PCP08) “I’ve even adjusted some of my recommendations based on it (tool) to reflect more clearly what is in the Pathway” (NEPH01)