WHO SHOULD PLACE PERITONEAL DIALYSIS CATHETERS?
WHO SHOULD PLACE PERITONEAL DIALYSIS CATHETERS?
复制标题
谁应该放置腹膜透析导管？
DOI：
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发表时间：
2010
影响因子：
2.8
通讯作者：
J. Crabtree
中科院分区：
文献类型：
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作者：
J. Crabtree
企业背景：由于外科医生在放置导管方面的表现不佳，肾科医生在尝试扩大腹膜透析计划时经常受挫。肾科医生呼吁加强透析服务提供者的作用。目的：哪些因素影响肾脏科医师成为主要透析通路提供者的可行性？为什么外科医生没有完成他们的任务，有什么可以激励他们改变他们的表现和改善结果？方法：虽然这些问题是普遍的，但本分析侧重于美国目前的实践数据。审查的证据包括透析中心规模和年度新开工、执行导管放置的专科概况、肾脏病学劳动力能力、导管植入方法、腹膜通路的资源利用和外科医生的表现。结果：目前的肾脏病学工作人员正在以最大能力运行，奖学金培训计划将难以满足额外的需求。肾脏病学培训计划通常在提供足够的腹膜透析管理经验方面存在不足。只有2.3%的腹膜导管是由肾科医生放置的。外科医生使用的腹腔镜方法可以产生最佳的导管结果。与其他导管放置技术相比，腹腔镜手术能够获得更大的患者候选人群。尽管如此，次优手术性能与培训不足、手术量低和报销不佳有关。结论：肾脏科医生不太可能扩大他们的实践范围，承担透析通路提供者的额外角色。现有外科工作人员的绩效可以通过医学会赞助的教育活动、将进入程序引导给指定的外科医生以及通过基于结果的激励计划提高报酬来提高。
♦ Background: Nephrologists are often thwarted in their attempts to grow their peritoneal dialysis programs because of suboptimal surgeon performance in placing catheters. A rallying call is heard among nephrologists to step up to the role of dialysis access providers. ♦ Objective: What factors influence the practicability of nephrologists becoming primary dialysis access providers? Why have surgeons failed their task and can anything motivate them to change their performance and improve outcomes? ♦ Methods: While the issues are universal, this analysis focuses on current practice data from the United States. Evidence reviewed includes dialysis center size and annual new starts, profile of specialties performing catheter placement, nephrology workforce capacity, catheter implantation methodology, resource utilization for peritoneal access, and surgeon performance. ♦ Results: The current nephrology workforce is running at maximum capacity and fellowship training programs will struggle to meet additional demands. Nephrology training programs are often deficient in providing adequate experience in peritoneal dialysis management. Only 2.3% of peritoneal catheters are placed by nephrologists. The best catheter outcomes are produced by laparoscopic methods used by surgeons. Compared to other catheter placement techniques, laparoscopy enables a larger candidate pool of patients. Nonetheless, suboptimal surgical performances are related to inadequate training, low procedure volume, and poor reimbursement. ♦ Conclusions: It is improbable that nephrologists can expand the scope of their practice to assume the additional role of dialysis access providers. The performance of the existing surgical workforce can be enhanced through medical society-sponsored educational activities, channeling access procedures to designated surgeons, and improved remuneration through outcomes-based incentive programs.