Advanced CKD Care and Decision Making: Which Health Care Professionals Do Patients Rely on for CKD Treatment and Advice?
Advanced CKD Care and Decision Making: Which Health Care Professionals Do Patients Rely on for CKD Treatment and Advice?
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DOI：
10.1016/j.xkme.2020.05.008
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发表时间：
2020-09
期刊：
影响因子：
3.9
通讯作者：
PREPARE NOW study investigators
中科院分区：
文献类型：
--
作者：
Barrett TM;Green JA;Greer RC;Ephraim PL;Peskoe S;Pendergast JF;Hauer CL;Strigo TS;Norfolk E;Bucaloiu ID;Diamantidis CJ;Hill-Briggs FF;Browne T;Jackson GL;Boulware LE;PREPARE NOW study investigators
慢性肾病 (CKD) 护理通常分散在多个医疗保健提供者中。目前尚不清楚患者是否主要依赖肾病专家或非肾病专家提供医疗护理，包括 CKD 治疗和建议。横断面研究。在宾夕法尼亚州 CKD 诊所接受肾科护理的成年人。参与者肾脏病护理的频率、持续时间和以患者为中心（范围，1 [最少] 到 4 [最多]）。参与者对肾脏病专家、初级保健提供者或其他专家的医疗护理（包括 CKD 治疗和建议）的依赖。多变量逻辑回归可量化参与者对其肾病专家（相对于其他提供者）的依赖与其人口统计、合并症、肾功能和肾病护理之间的关联。在该研究目标诊所的 1,412 名患者中，有 676 名患者（48%）参与了研究。其中，453 名（67%）符合本次分析的条件。平均年龄为 71 (SD, 12) 岁，59% 为女性，97% 为白人，65% 为退休人员。参与者在过去 2 年内接受肾脏科护理的时间中位数为 3.8（IQR，2.0-6.6）年，并完成了中位数 4（IQR，3-5）次肾脏科预约。一半 (56%) 的参与者主要依赖肾脏科医生，23% 的人依赖初级保健提供者，18% 的人平等地依赖所有提供者，3% 的人依赖其他专家。对于那些接受肾内科护理时间较长的参与者（OR，1.08 [95% CI，1.02-1.15]；P = 0.02）、那些在过去 2 年内完成更多肾内科就诊的参与者（OR，1.16 [95% CI，1.05-1.29]；P = 0.005）以及那些认为自己最近一次就诊的参与者，依赖肾科医生的调整后的几率较高。与肾科医生的互动更加以患者为中心（OR，2.63 [95% CI，1.70-4.09]；P < 0.001）。单一卫生系统研究。许多肾病患者依赖非肾病专家提供医疗服务。以患者为中心的纵向肾脏病护理可能会鼓励更多患者遵循肾脏病专家的建议。
Chronic kidney disease (CKD) care is often fragmented across multiple health care providers. It is unclear whether patients rely mostly on their nephrologists or non-nephrologist providers for medical care, including CKD treatment and advice. Cross-sectional study. Adults receiving nephrology care at CKD clinics in Pennsylvania. Frequency, duration, and patient-centeredness (range, 1 [least] to 4 [most]) of participants’ nephrology care. Participants’ reliance on nephrologists, primary care providers, or other specialists for medical care, including CKD treatment and advice. Multivariable logistic regression to quantify associations between participants’ reliance on their nephrologists (vs other providers) and their demographics, comorbid conditions, kidney function, and nephrology care. Among 1,412 patients in clinics targeted for the study, 676 (48%) participated. Among these, 453 (67%) were eligible for this analysis. Mean age was 71 (SD, 12) years, 59% were women, 97% were white, and 65% were retired. Participants were in nephrology care for a median of 3.8 (IQR, 2.0-6.6) years and completed a median of 4 (IQR, 3-5) nephrology appointments in the past 2 years. Half (56%) the participants relied primarily on their nephrologists, while 23% relied on primary care providers, 18% relied on all providers equally, and 3% relied on other specialists. Participants’ adjusted odds of relying on their nephrologists were higher for those in nephrology care for longer (OR, 1.08 [95% CI, 1.02-1.15]; P = 0.02), those who completed more nephrology visits in the previous 2 years (OR, 1.16 [95% CI, 1.05-1.29]; P = 0.005), and those who perceived their last interaction with their nephrologists as more patient-centered (OR, 2.63 [95% CI, 1.70-4.09]; P < 0.001). Single health system study. Many nephrology patients relied on non-nephrologist providers for medical care. Longitudinal patient-centered nephrology care may encourage more patients to follow nephrologists’ recommendations.
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DOI：
10.2215/cjn.06240710
发表时间：
2011-02-01
影响因子：
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作者：
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DOI：
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发表时间：
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影响因子：
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作者：
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