Provider Knowledge, Attitudes, and Practices Surrounding Conservative Management for Patients with Advanced CKD
Provider Knowledge, Attitudes, and Practices Surrounding Conservative Management for Patients with Advanced CKD
复制标题
DOI：
10.2215/cjn.07180715
复制
发表时间：
2016-05-06
影响因子：
9.8
通讯作者：
Unruh, Mark
中科院分区：
文献类型：
--
作者：
Parvez, Sanah;Abdel-Kader, Khaled;Unruh, Mark
背景和目的尽管保守治疗有潜在的益处，但提供者很少将其作为晚期CKD患者的可行治疗选择进行讨论。这项调查是描述的知识，态度和做法的肾脏病学家和初级保健提供者保守治疗晚期CKD患者在UnitedStates.Design，设置，参与者和测量我们开发了一个问卷的基础上，文献综述，包括项目评估知识，态度和自我报告的做法保守治疗晚期CKD患者。使用美国医学会医师主文件识别潜在参与者。结果431名医务人员（67.6%为肾内科医生，32.4%为基层医疗服务提供者）完成了问卷调查，粗回复率为2.7%。受访者一般是白色、男性，年龄在30多岁和40多岁之间。大多数初级保健提供者（83.5%）和肾脏病学（78.2%）受访者报告称，他们可能会与患有晚期CKD的老年患者讨论保守治疗。30.6%的肾病学家和49.2%的初级保健提供者自我报告的保守治疗患者数量>11例。肾脏病学家更可能支持难以确定CKD患者是否会从保守治疗中获益（52.8%对36.2%的初级保健提供者），而初级保健提供者更有可能认可有限的有效性信息（49.6%对24.5%的肾病学家）和难以确定保守治疗的资格（42.5%对14.3%的肾病学家）。也有显着差异的知识组之间，与初级保健提供者报告保守治疗的相对生存率的不确定性与不同的患者groups.Conclusions相比，肾脏科医生和初级保健提供者报告舒适与他们的患者讨论保守治疗。然而，这两个提供者群体都认为，缺乏美国关于保守治疗结局的数据以及从保守治疗中受益的患者特征是在实践中推荐保守治疗的障碍。
Background and objectives Despite the potential benefits of conservative management, providers rarely discuss it as a viable treatment option for patients with advanced CKD. This survey was to describe the knowledge, attitudes, and practices of nephrologists and primary care providers regarding conservative management for patients with advanced CKD in the United States.Design, setting, participants, & measurements We developed a questionnaire on the basis of a literature review to include items assessing knowledge, attitudes, and self-reported practices of conservative management for patients with advanced CKD. Potential participants were identified using the American Medical Association Physician Masterfile. We then conducted a web-based survey between April and May of 2015.Results In total, 431 (67.6% nephrologists and 32.4% primary care providers) providers completed the survey for a crude response rate of 2.7%. The respondents were generally white, men, and in their 30s and 40s. Most primary care provider (83.5%) and nephrology (78.2%) respondents reported that they were likely to discuss conservative management with their older patients with advanced CKD. Self-reported number of patients managed conservatively was >11 patients for 30.6% of nephrologists and 49.2% of primary care providers. Nephrologists were more likely to endorse difficulty determining whether a patient with CKD would benefit from conservative management (52.8% versus 36.2% of primary care providers), whereas primary care providers were more likely to endorse limited information on effectiveness (49.6% versus 24.5% of nephrologists) and difficulty determining eligibility for conservative management (42.5% versus 14.3% of nephrologists). There were also significant differences in knowledge between the groups, with primary care providers reporting more uncertainty about relative survival rates with conservative management compared with different patient groups.Conclusions Both nephrologists and primary care providers reported being comfortable with discussing conservative management with their patients. However, both provider groups identified lack of United States data on outcomes of conservative management and characteristics of patients who would benefit from conservative management as barriers to recommending conservative management in practice.