Nephrologists' likelihood of referring patients for kidney transplant based on hypothetical patient scenarios.
Nephrologists' likelihood of referring patients for kidney transplant based on hypothetical patient scenarios.
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DOI：
10.1093/ckj/sfw031
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发表时间：
2016-08
影响因子：
4.6
通讯作者：
Ghahramani N
中科院分区：
文献类型：
--
作者：
Tandon A;Wang M;Roe KC;Patel S;Ghahramani N
肾移植和先发性肾移植（PKT）的转诊存在很大差异。年龄、种族、性别和地理位置等患者特征被认为是造成这种差异的因素。我们假设肾脏科医生的特征与患者的特征相互作用，从而影响转诊决策。在这项研究中，我们使用假设的病例场景来评估肾病专家关于移植转诊的决定。共有3180名肾脏病专家受邀参加。在感兴趣的人中，随机选择了 252 人接受一项调查，调查中询问肾科医生是否会建议这 25 名假设的患者进行移植。使用具有单协变量和多协变量的逻辑回归模型来识别与转诊移植可能性相关的患者特征，并识别与转诊移植可能性相关的肾病专家特征。在 252 名潜在参与者中，216 人完成了调查。肾病专家与学术机构的隶属关系与转诊的可能性较高相关，而“距研究资格超过 10 年”则与转诊患者进行移植的可能性较低相关。患者年龄 <50 岁与转诊的可能性较高相关。农村地区和吸烟史/慢性阻塞性肺疾病与转诊接受移植的可能性较低有关。肾科医生与学术机构的隶属关系与转诊进行先发性移植的可能性较高相关，而居住在农村的患者与转诊进行先发性移植的可能性较低相关。移植转诊的可变性与患者的年龄和地理位置以及肾病专家与学术机构的隶属关系以及完成培训后的时间有关。未来的教育干预措施应强调肾移植和 PKT 对所有人群的益处，无论其地理位置和年龄如何，并应针对非学术环境中接受过专科培训 10 年或以上的肾病专家。
There is wide variation in referral for kidney transplant and preemptive kidney transplant (PKT). Patient characteristics such as age, race, sex and geographic location have been cited as contributing factors to this disparity. We hypothesize that the characteristics of nephrologists interplay with the patients' characteristics to influence the referral decision. In this study, we used hypothetical case scenarios to assess nephrologists' decisions regarding transplant referral. A total of 3180 nephrologists were invited to participate. Among those interested, 252 were randomly selected to receive a survey in which nephrologists were asked whether they would recommend transplant for the 25 hypothetical patients. Logistic regression models with single covariates and multiple covariates were used to identify patient characteristics associated with likelihood of being referred for transplant and to identify nephrologists' characteristics associated with likelihood of referring for transplant. Of the 252 potential participants, 216 completed the survey. A nephrologist's affiliation with an academic institution was associated with a higher likelihood of referral, and being ‘>10 years from fellowship’ was associated with lower likelihood of referring patients for transplant. Patient age <50 years was associated with higher likelihood of referral. Rural location and smoking history/chronic obstructive pulmonary disease were associated with lower likelihood of being referred for transplant. The nephrologist's affiliation with an academic institution was associated with higher likelihood of referring for preemptive transplant, and the patient having a rural residence was associated with lower likelihood of being referred for preemptive transplant. The variability in transplant referral is related to patients' age and geographic location as well as the nephrologists' affiliation with an academic institution and time since completion of training. Future educational interventions should emphasize the benefits of kidney transplant and PKT for all population groups regardless of geographic location and age and should target nephrologists in non-academic settings who are 10 or more years from their fellowship training.