Kidney Medicine (Sep 2020)

Advanced CKD Care and Decision Making: Which Health Care Professionals Do Patients Rely on for CKD Treatment and Advice?Plain-Language Summary

  • Tyler M. Barrett,
  • Jamie A. Green,
  • Raquel C. Greer,
  • Patti L. Ephraim,
  • Sarah Peskoe,
  • Jane F. Pendergast,
  • Chelsie L. Hauer,
  • Tara S. Strigo,
  • Evan Norfolk,
  • Ion Dan Bucaloiu,
  • Clarissa J. Diamantidis,
  • Felicia F. Hill-Briggs,
  • Teri Browne,
  • George L. Jackson,
  • L. Ebony Boulware,
  • L. Ebony Boulware,
  • Clarissa Diamantidis,
  • Clare Il’Giovine,
  • George Jackson,
  • Jane Pendergast,
  • Sarah Peskoe,
  • Tara Strigo,
  • Jon Billet,
  • Jason Browne,
  • Ion Bucaloiu,
  • Charlotte Collins,
  • Daniel Davis,
  • Sherri Fulmer,
  • Jamie Green,
  • Chelsie Hauer,
  • Evan Norfolk,
  • Michelle Richner,
  • Cory Siegrist,
  • Wendy Smeal,
  • Rebecca Stametz,
  • Mary Solomon,
  • Christina Yule,
  • Patti Ephraim,
  • Raquel Greer,
  • Felicia Hill-Briggs,
  • Teri Browne,
  • Navdeep Tangri,
  • Brian Bankes,
  • Shakur Bolden,
  • Patricia Danielson,
  • Katina Lang-Lindsey,
  • Suzanne Ruff,
  • Lana Schmidt,
  • Amy Swoboda,
  • Peter Woods,
  • Diana Clynes,
  • Stephanie Stewart,
  • Dori Schatell,
  • Kristi Klicko,
  • Brandi Vinson,
  • Jennifer St. Clair Russell,
  • Kelli Collins,
  • Jennifer Martin,
  • Dale Singer,
  • Diane Littlewood

Journal volume & issue
Vol. 2, no. 5
pp. 532 – 542.e1

Abstract

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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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