Frequency of patient-physician contact and patient outcomes in hemodialysis care
Frequency of patient-physician contact and patient outcomes in hemodialysis care
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DOI：
10.1097/01.asn.0000106101.48237.9d
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发表时间：
2004-01-01
影响因子：
13.6
通讯作者：
Powe, NR
中科院分区：
文献类型：
--
作者：
Plantinga, LC;Fink, NE;Powe, NR
几乎没有证据支持人们普遍认为，在慢性病管理中定期进行医患接触可以带来更好的患者治疗结果。本研究的目的是检查医患接触频率与 1995 年开始的一项前瞻性队列研究中几种患者结果的关系，研究对象是在 75 个美国透析诊所接受治疗的血液透析患者。每个诊所的患者与医生接触的平均频率是通过临床调查确定的（低，每月或较低频率；中，每月和每周之间；高，每周以上）。作者使用逻辑、泊松和 Cox 比例风险回归分析来评估接触与满意度、生活质量、患者依从性、住院治疗和死亡率之间的关系。在735名血液透析患者中，14.3%在接触频率较高的诊所接受治疗，65.2%在接触频率较高的诊所接受治疗，20.5%在接触频率较低的诊所接受治疗。在报告医生接触频率较低的诊所接受治疗的患者，对肾科医生就诊频率评价为优秀的几率较低（低：调整后 OR = 0.39，95% CI，0.23-0.67；中：调整后 OR = 0.57，95% CI，0.37-0.87；参考，高），不依从的可能性较大（低：调整后 OR = 2.89，95% CI， 1.01-8.29；中间：调整后 OR = 1.58，95% CI，0.78-3.19）。然而，患者的生存率并不因医生接触频率而变化（低：调整后的 RH = 0.87，95% CI，0.53-1.44；中：调整后的 RH = 1.33，95% CI，0.82-2.13），患者的护理总体评分、住院率或生活质量指标也没有变化。尽管医患接触频率较低与患者对接触的满意度较低和患者不依从性相关，但它与其他几种护理结果无关。未来的研究需要评估随着时间的推移医生接触的频率和性质，包括与患者相处的总时间和互动的质量，以指导提供以患者为中心和具有成本效益的护理。
There is little evidence supporting the widespread belief that regular patient-physician contact in chronic disease management leads to better patient outcomes. The objective of this study was to examine the relationship of the frequency of patient-physician contact with several patient outcomes in a prospective cohort study begun in 1995 of incident hemodialysis patients treated at 75 US dialysis clinics. Average frequency of patient-physician contact at each clinic was determined by clinic survey (low, monthly or less frequent; intermediate, between monthly and weekly; high, more than weekly). The authors used logistic, Poisson, and Cox proportional hazards regression analyses to assess the relationship between contact and satisfaction, quality of life, patient adherence, hospitalizations, and mortality. Of 735 hemodialysis patients, 14.3% were treated at clinics with high frequency of contact, 65.2% intermediate, and 20.5% low. Patients treated at clinics reporting less frequent physician contact had lower odds of rating the frequency at which they saw a nephrologist excellent (low: adjusted OR = 0.39, 95% CI, 0.23-0.67; intermediate: adjusted OR = 0.57, 95% CI, 0.37-0.87; reference, high) and greater odds of nonadherence (low: adjusted OR = 2.89, 95% CI, 1.01-8.29; intermediate: adjusted OR = 1.58, 95% CI, 0.78-3.19). However, patient survival did not vary by frequency of physician contact (low: adjusted RH = 0.87, 95% CI, 0.53-1.44; intermediate: adjusted RH = 1.33, 95% CI, 0.82-2.13), nor did patients' overall ratings of care, hospitalization rates, or quality of life measures. Although less frequent patient-physician contact was associated with lower patient satisfaction with that contact and patient nonadherence, it was not associated with several other outcomes of care. Future studies are needed to assess the individual frequency and nature of physician contact over time, including total time spent with the patient and quality of the interaction, to guide the provision of patient-centered and cost-effective care.