Awareness and Knowledge of Clinical Practice Guidelines for CKD Among Internal Medicine Residents: A National Online Survey
Awareness and Knowledge of Clinical Practice Guidelines for CKD Among Internal Medicine Residents: A National Online Survey
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DOI：
10.1053/j.ajkd.2008.06.022
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发表时间：
2008-12-01
影响因子：
13.2
通讯作者：
McCullough, Peter A.
中科院分区：
文献类型：
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作者：
Agrawal, Varun;Ghosh, Amit K.;McCullough, Peter A.
背景：国家肾脏基金会发布了肾脏疾病结果质量倡议指南，建议早期发现和管理慢性肾脏疾病 (CKD)，并及时转诊给肾病专家。许多 CKD 患者由初级保健医生接诊，但他们的经验不如肾脏科医生，无法提供最佳的终末期肾病治疗。目前尚不清楚当前的研究生培训是否为未来的 CKD 管理内科医生做好了充分的准备。研究设计：使用在线问卷调查进行横断面研究。设置和参与者：美国内科住院医师 (n = 479)，研究生年 (PGY) 分布为 166 PGY1、187 PGY2 和 126 PGY3。预测变量：通过使用结果和测量：总表现得分（最高 = 30）。结果：一半的居民不知道 3 个月或更长时间存在肾脏损害（蛋白尿）可定义为 CKD。三分之一的居民不知道 CKD 的分期。所有居民（99%）都知道糖尿病和高血压等慢性肾病的传统危险因素，但对肥胖（38%）、高龄（71%）和非洲裔美国人（68%）等其他危险因素知之甚少。大多数居民 (87%) 知道评估 CKD 患者时估计的肾小球滤过率。大多数居民 (90%) 知道 CKD 患者的目标血压 (< 130/80 mm Hg)。大多数居民认为贫血 (91%) 和骨病 (82%) 是 CKD 的并发症，但只有一半的居民认为 CKD 是心血管疾病的危险因素。大多数住院医生 (90%) 选择将肾小球滤过率低于 30 mL/min/1.73 m(2) 的患者转诊给肾病专家。随着 PGY 的增加，观察到平均表现得分略有提高（PGY1，68.8% +/- 15.4%；PGY2，72.9% +/- 14.7%；PGY3，74.0% +/- 12.0%；P = 0.004）。局限性：自我选择，缺乏非应答数据。结论：我们的调查发现了在知识方面的具体差距内科住院医师 CKD 指南。提高对这些指南的认识的教育工作可能会改善 CKD 管理和临床结果。
Background: The National Kidney Foundation published Kidney Disease Outcomes Quality Initiative guidelines that recommend early detection and management of chronic kidney disease (CKD) and timely referral to a nephrologist. Many patients with CKD are seen by primary care physicians who are less experienced than nephrologists to offer optimal pre-end-stage renal disease care. It is not known whether current postgraduate training adequately prepares a future internist in CKD management.Study Design: Cross-sectional study using an online questionnaire survey.Setting & Participants: Internal medicine residents in the United States (n = 479) with postgraduate year (PGY) distribution of 166 PGY1, 187 PGY2, and 126 PGY3.Predictor: Awareness and knowledge of CKD clinical practice guidelines measured by using the questionnaire instrument.Outcomes & Measurements: Total performance score (maximum = 30).Results: Half the residents did not know that the presence of kidney damage (proteinuria) for 3 or more months defines CKD. One-third of the residents did not know the staging of CKD. All residents (99%) knew the traditional risk factors for CKD of diabetes and hypertension, but were less aware of other risk factors of obesity (38%), elderly age (71%), and African American race (68%). Most residents (87%) were aware of estimated glomerular filtration rate in the evaluation of patients with CKD. Most residents (90%) knew goal blood pressure (< 130/80 mm Hg) for patients with CKD. Most residents identified anemia (91%) and bone disorder (82%) as complications of CKD, but only half recognized CKD as a risk factor for cardiovascular disease. Most residents (90%) chose to refer a patient with a glomerular filtration rate less than 30 mL/min/1.73 m(2) to a nephrologist. A small improvement in mean performance score was observed with increasing PGY (PGY1, 68.8% +/- 15.4%; PGY2, 72.9% +/- 14.7%; and PGY3, 74.0% +/- 12.0%; P = 0.004).Limitations: Self-selection, lack of nonrespondent data.Conclusions: Our survey identified specific gaps in knowledge of CKD guidelines in internal medicine residents. Educational efforts in increasing awareness of these guidelines may improve CKD management and clinical outcomes.