Primary Care Involvement and Health Care Utilization Among Patients With End-Stage Kidney Disease

Area of Science:

• Nephrology
• Primary Care Medicine
• Health Services Research

Background:

• Patients with end-stage kidney disease (ESKD) undergoing dialysis experience high rates of emergency department (ED) visits and hospitalizations.
• The role of primary care physicians (PCPs) in mitigating these adverse events in the ESKD population remains unclear.
• Effective care models are needed to reduce healthcare utilization among dialysis patients.

Purpose of the Study:

• To investigate the association between PCP involvement and the risk of hospitalization and ED utilization in patients with ESKD on dialysis.
• To determine if enhanced primary care engagement can reduce healthcare burdens in this vulnerable patient group.

Main Methods:

• Retrospective, cross-sectional study analyzing Medicare Fee for Service data for ESKD patients on dialysis (January 2018 - December 2019).
• Utilized differential distance to high PCP involvement dialysis facilities as an instrumental variable to estimate PCP association.
• Analyzed data on ED visits (with or without hospitalization) and hospitalizations as primary outcomes.

Main Results:

• Patients with estimated PCP involvement showed a significantly lower risk of ED visits not resulting in hospitalization (51.2% vs. 72.1%, P < .001).
• Overall ED visit risk was also reduced in patients with estimated PCP involvement (69.4% vs. 75.0%).
• No significant association was found between PCP involvement and the risk of hospitalization.

Conclusions:

• Primary care physician involvement is associated with a significant reduction in emergency department utilization among patients with end-stage kidney disease receiving dialysis.
• These findings suggest that integrating primary care can be a valuable strategy for managing ESKD patients and optimizing healthcare resource use.
• Further research may explore specific primary care interventions to further reduce hospitalizations in this population.