Associations of Frequency and Duration of Patient-Doctor Contact in Hemodialysis Facilities with Mortality
Associations of Frequency and Duration of Patient-Doctor Contact in Hemodialysis Facilities with Mortality
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DOI：
10.1681/asn.2012080831
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发表时间：
2013-09-01
影响因子：
13.6
通讯作者：
Saran, Rajiv
中科院分区：
文献类型：
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作者：
Kawaguchi, Takehiko;Karaboyas, Angelo;Saran, Rajiv
目前尚不清楚定期的医患接触(PDC)是否有助于血液透析患者获得更好的结果。在这里，我们分析了国际透析结果和实践模式研究(DOPPS)中来自778个机构的24,498名患者在血液透析治疗期间PDC的频率和持续时间与临床结果的关系。据设施人员估计，典型的设施PDC频率为55%的设施为高频率(每周一次以上)，中等频率(每周一次)为24%，低频率(每周少于一次)为21%。患者和医生之间典型互动的平均+/-SD估计持续时间为7.7+/-5.6分钟。PDC频率和持续时间因DOPPS阶段和国家而异；PDC频率较高的设施比例在美国为17%，在其他国家为73%。与高PDC频率相比，中PDC频率和低PDC频率的全因死亡的调整危险比(HR)分别为1.06(95%可信区间，0.96~1.17)和1.11(95%CI，1.01~1.23，趋势P=0.03)。此外，在调整了PDC频率和其他协变量后，PDC持续时间每缩短5分钟，死亡风险平均增加5%(HR，1.05；95%CI，1.01至1.09)。多变量分析还表明，PDC频率和持续时间与住院之间存在适度的负相关，但与肾移植无关。综上所述，这些结果表明，支持更频繁和更长持续时间的PDC的政策可能会改善血液透析患者的预后。
It is unknown whether regular patient-doctor contact (PDC) contributes to better outcomes for patients undergoing hemodialysis. Here, we analyzed the associations between frequency and duration of PDC during hemodialysis treatments with clinical outcomes among 24,498 patients from 778 facilities in the international Dialysis Outcomes and Practice Patterns Study (DOPPS). The typical facility PDC frequency, estimated by facility personnel, was high (more than once per week) for 55% of facilities, intermediate (once per week) for 24%, and low (less than once per week) for 21%. The mean +/- SD estimated duration of a typical interaction between patient and physician was 7.7 +/- 5.6 minutes. PDC frequency and duration varied across DOPPS phases and countries; the proportion of facilities with high PDC frequency was 17% in the United States and 73% across the other countries. Compared with high PDC frequency, the adjusted hazard ratio (HR) for all-cause mortality was 1.06 (95% confidence interval [CI], 0.96 to 1.17) for intermediate PDC frequency and 1.11 (95% CI, 1.01 to 1.23) for low PDC frequency (P=0.03 for trend). Furthermore, each 5-minutes-shorter duration of PDC was associated with a 5% higher risk for death, on average (HR, 1.05; 95% CI, 1.01 to 1.09), adjusted for PDC frequency and other covariates. Multivariable analyses also suggested modest inverse associations between both PDC frequency and duration with hospitalization but not with kidney transplantation. Taken together, these results suggest that policies supporting more frequent and longer duration of PDC may improve patient outcomes in hemodialysis.