Effect of primary care physicians' use of estimated glomerular filtration rate on the timing of their subspecialty referral decisions.
Effect of primary care physicians' use of estimated glomerular filtration rate on the timing of their subspecialty referral decisions.
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DOI：
10.1186/1471-2369-12-1
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发表时间：
2011-01-14
期刊：
影响因子：
2.3
通讯作者：
Boulware LE
中科院分区：
文献类型：
--
作者：
Greer RC;Powe NR;Jaar BG;Troll MU;Boulware LE
初级保健提供者对慢性肾脏疾病(CKD)严重性的次优认识可能会导致CKD患者过早地转诊到专科护理。目前尚不清楚美国初级保健医生使用估计的肾小球滤过率(EGFR)而不是血清肌酐来评估CKD的严重性是否可以改善他们专科转诊决定的及时性。我们对154名美国初级保健医生进行了一项横断面研究，以评估使用EGFR(与肌酐相比)对他们专科转诊时间的影响。初级保健医生完成了一份问卷，内容是关于一名假想的患有CKD的白人或非裔美国人患者的问题。我们要求初级保健医生确定他们会建议像假想患者这样的患者进行专科评估时的血清肌酐和EGFR水平。我们评估了他们推荐的转诊时间[从30毫升/分钟增加到≥30毫升/分钟/1.73m2]的显著改善，这是基于他们使用肌酸而不是EGFR。初级保健医生建议稍后在使用肌酐和EGFR评估肾功能时转诊专科医生[中位数EGFR分别为32和55毫升/分钟/1.73米2，p<；0.001]。40%的初级保健医生在根据EGFR提出建议时，显著改善了转诊的时间。在从事学术(与非学术)实践或呈现白人(与非裔美国人)假想患者的初级保健医生中，改善的时机发生得更频繁[调整后的百分比(95%CI)：70%(45-87)与37%(参考)和57%(39-73)与25%(参考)，均p≤0.01)。初级保健医生建议在早期使用EGFR(与肌酐相比)评估肾功能时转诊专科。初级保健医生加强对EGFR的使用可以导致更及时的专科护理，并改善CKD患者的临床结果。
Primary care providers' suboptimal recognition of the severity of chronic kidney disease (CKD) may contribute to untimely referrals of patients with CKD to subspecialty care. It is unknown whether U.S. primary care physicians' use of estimated glomerular filtration rate (eGFR) rather than serum creatinine to estimate CKD severity could improve the timeliness of their subspecialty referral decisions. We conducted a cross-sectional study of 154 United States primary care physicians to assess the effect of use of eGFR (versus creatinine) on the timing of their subspecialty referrals. Primary care physicians completed a questionnaire featuring questions regarding a hypothetical White or African American patient with progressing CKD. We asked primary care physicians to identify the serum creatinine and eGFR levels at which they would recommend patients like the hypothetical patient be referred for subspecialty evaluation. We assessed significant improvement in the timing [from eGFR < 30 to ≥ 30 mL/min/1.73m2) of their recommended referrals based on their use of creatinine versus eGFR. Primary care physicians recommended subspecialty referrals later (CKD more advanced) when using creatinine versus eGFR to assess kidney function [median eGFR 32 versus 55 mL/min/1.73m2, p < 0.001]. Forty percent of primary care physicians significantly improved the timing of their referrals when basing their recommendations on eGFR. Improved timing occurred more frequently among primary care physicians practicing in academic (versus non-academic) practices or presented with White (versus African American) hypothetical patients [adjusted percentage(95% CI): 70% (45-87) versus 37% (reference) and 57% (39-73) versus 25% (reference), respectively, both p ≤ 0.01). Primary care physicians recommended subspecialty referrals earlier when using eGFR (versus creatinine) to assess kidney function. Enhanced use of eGFR by primary care physicians' could lead to more timely subspecialty care and improved clinical outcomes for patients with CKD.
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DOI：
10.1053/j.ajkd.2008.05.023
发表时间：
2008-10
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Accetta NA;Gladstone EH;DiSogra C;Wright EC;Briggs M;Narva AS
通讯作者：
Narva AS
影响因子：
39.2
作者：
Kinchen, KS;Sadler, J;Powe, NR
通讯作者：
Powe, NR
影响因子：
6.1
作者：
Hobbs, Helen;Stevens, Paul;Farmer, Christopher
通讯作者：
Farmer, Christopher
影响因子：
2.9
作者：
Fox, Chester H.;Brooks, Amanda;Murray, Brian
通讯作者：
Murray, Brian
影响因子：
16.2
作者：
Johnson, Susan L.;Tierney, Edward F.;Herman, William H.
通讯作者：
Herman, William H.