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Advanced CKD Care and Decision Making: Which Health Care Professionals Do Patients Rely on for CKD Treatment and
Tyler M Barrett1, Jamie A Green2,3, Raquel C Greer4,5
1Division of General Internal Medicine, Duke University School of Medicine, Durham, NC.
Insights
Many chronic kidney disease (CKD) patients rely on non-nephrologists for care. Patient-centered, longitudinal nephrology care may improve adherence to recommendations.
Area of Science:
- Nephrology
- Health Services Research
Background:
- Chronic kidney disease (CKD) care is often fragmented among multiple providers.
- It remains unclear whether patients primarily rely on nephrologists or other providers for medical guidance and treatment.
Purpose of the Study:
- To investigate patient reliance on nephrologists versus non-nephrologist providers for medical care in CKD patients.
- To identify factors associated with patients' primary reliance on nephrologists.
Main Methods:
- Cross-sectional study of adult CKD patients receiving care at Pennsylvania CKD clinics.
- Multivariable logistic regression analyzed associations between reliance on nephrologists and patient demographics, comorbidities, kidney function, and nephrology care characteristics.
Main Results:
- Of 453 eligible participants, 56% relied primarily on nephrologists, 23% on primary care providers, and 18% equally on all providers.
- Longer duration of nephrology care (OR, 1.08), more frequent nephrology visits (OR, 1.16), and higher patient-centeredness of interactions (OR, 2.63) were associated with increased reliance on nephrologists.
Conclusions:
- A significant proportion of CKD patients depend on non-nephrologist providers for medical care.
- Longitudinal, patient-centered nephrology care may foster greater patient reliance on nephrologists and adherence to their recommendations.
Rationale & Objective:
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.
Study Design:
Cross-sectional study.
Setting & Participants:
Adults receiving nephrology care at CKD clinics in Pennsylvania.
Predictors:
Frequency, duration, and patient-centeredness (range, 1 [least] to 4 [most]) of participants' nephrology care.
Outcome:
Participants' reliance on nephrologists, primary care providers, or other specialists for medical care, including CKD treatment and advice.
Analytical Approach:
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.
Results:
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).
Limitations:
Single health system study.
Conclusions:
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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