Primary Care-Specialist Collaboration in the Care of Patients with Chronic Kidney Disease
Primary Care-Specialist Collaboration in the Care of Patients with Chronic Kidney Disease
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DOI：
10.2215/cjn.06240710
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发表时间：
2011-02-01
影响因子：
9.8
通讯作者：
Boulware, L. Ebony
中科院分区：
文献类型：
--
作者：
Diamantidis, Clarissa Jonas;Powe, Neil R.;Boulware, L. Ebony
背景和目标 广泛提倡初级保健医生 (PCP) 和肾脏病专家在慢性肾脏病 (CKD) 患者的护理中进行合作，但医生对合作的偏好尚不清楚。评估了医生在治疗假设的 CKD 患者方面的合作意愿、他们偏好的合作内容以及他们感知到的合作障碍。设计、设置、参与者和测量向美国 PCP 和肾脏病专家的全国样本发放了一份描述假设的进行性 CKD 患者的护理的调查问卷。确定了与合作愿望相关的医生特征和态度。结果 在 124 名 PCP 和 120 名肾病专家中，大多数医生（85% PCP 和 94% 肾病专家）希望合作。与 PCP 相比，肾病专家更有可能更倾向于将合作重点放在透析前/肾脏替代治疗准备和电解质管理上（分别为 73% 与 52% 和 81% 与 46%）。如果假设的患者患有糖尿病和高血压（相对于单纯高血压），如果他们相信自己提供的护理有助于减缓 CKD 疾病进展，并且如果他们不认为健康保险是肾脏病转诊的障碍，则 PCP 更有可能希望合作（调整后的百分比 [95% 置信区间]：94% [80 至 98] 对比 75% [参考]）、92% [75 至 981 对比 75% [参考]、42% [分别为 9% 至 851% 与 88%[参考]）。 结论 大多数 PCP 和肾脏病专家赞成对进展性 CKD 患者进行协作护理，但他们偏好的协作内容不同。明确将 PCP 纳入 CKD 患者护理的协作模型可能有助于改善患者的临床结果。 Clin J Am Soc Nephrol 6：334-343，2011。doi：10.2215/CJN.06240710
Background and objectives Collaboration between primary care physicians (PCPs) and nephrologists in the care of patients with chronic kidney disease (CKD) is widely advocated, but physician preferences regarding collaboration are unknown. Physicians' desires to collaborate in the care of a hypothetical patient with CKD, their preferred content of collaboration, and their perceived barriers to collaboration were assessed.Design, setting, participants, & measurements A questionnaire describing the care of a hypothetical patient with progressive CKD was administered to a national sample of U.S. PCPs and nephrologists. Physician characteristics and attitudes associated with desires to collaborate were identified.Results Among 124 PCPs and 120 nephrologists, most physicians (85% PCPs versus 94% nephrologists) desired collaboration. Nephrologists were more likely than PCPs to prefer collaboration focus on predialysis/renal replacement therapy preparation and electrolyte management (73% versus 52% and 81% versus 46%, respectively). PCPs were more likely to desire collaboration if the hypothetical patient had diabetes and hypertension (versus hypertension alone), if they believed the care they provide helps slow CKD disease progression, and if they did not perceive health insurance as a barrier to nephrology referral (adjusted percentages [95% confidence interval]: 94% [80 to 98] versus 75% [reference]), 92% [75 to 981 versus 75% [reference], 42% [9 to 851 versus 88% [reference], respectively).Conclusions Most PCPs and nephrologists favored collaborative care for a patient with progressive CKD, but their preferred content of collaboration differed. Collaborative models that explicitly include PCPs in the care of patients with CKD may help improve patients' clinical outcomes. Clin J Am Soc Nephrol 6: 334-343, 2011. doi: 10.2215/CJN.06240710