Provider perspectives of clinical decision support for chronic kidney disease management: a cross-sectional study

Abstract

Abstract Background Chronic kidney disease (CKD) affects approximately one in ten adults globally. Multiple studies have identified underuse of effective therapies in eligible patients with CKD despite guideline endorsement. Clinical decision support (CDS) may increase confidence in prescribing recommended medications, but how end-users perceive it is unknown. Objectives To evaluate clinician-reported perspectives and acceptability of CDS elements for ambulatory CKD management and inform the development of a CKD-specific CDS intervention. Methods Eligible participants for this electronic cross-sectional study were prescribing clinicians from Alberta, Canada, that practiced in ambulatory care settings, including physicians, nurse practitioners, and pharmacists. The survey presented examples of a proposed CDS’ content and format, and collected information on clinician demographics, CKD workflows, perceptions of CDS design, perceived acceptability and clinical utility. Knowledge, comfort, and prescribing patterns were examined for renin-angiotensin system inhibitors (RASi), statins, sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and non-steroidal mineralocorticoid receptor agonists (nsMRA). Participant comfort prescribing each medication class was compared using mean paired differences before and after viewing the proposed CDS. Results Between May and June 2025, 137 clinicians engaged with the survey, 131 completed demographics and 111 completed all survey elements. Most were nephrologists (n = 42; 32%) or general internal medicine specialists (n = 36; 27%). Overall, 88 (79%) supported CDS integration. RASi had the highest self-reported comfort with prescribing followed by statins, SGLT2i, GLP-1RA, and nsMRA. Clinicians reported higher comfort prescribing GLP-1RA and nsMRA with CDS support (median +1 on 9-point scale; p < 0.001), but no change for RASi, statins, and SGLT2i. Participants with low baseline comfort (≤6 on 9-point Likert scale) had statistically significant improvements in comfort with CDS for GLP-1RA and nsMRA (p < 0.05), but no change was observed for those with high baseline comfort. Conclusions Clinicians support CDS integration to enhance CKD care in ambulatory settings. The proposed CDS increased perceived prescribing confidence, particularly for GLP-1RA and nsMRA.