TY - JOUR
T1 - Advanced CKD Care and Decision Making
T2 - Which Health Care Professionals Do Patients Rely on for CKD Treatment and Advice?
AU - PREPARE NOW study investigators
AU - Barrett, Tyler M.
AU - Green, Jamie A.
AU - Greer, Raquel C.
AU - Ephraim, Patti L.
AU - Peskoe, Sarah
AU - Pendergast, Jane F.
AU - Hauer, Chelsie L.
AU - Strigo, Tara S.
AU - Norfolk, Evan
AU - Bucaloiu, Ion Dan
AU - Diamantidis, Clarissa J.
AU - Hill-Briggs, Felicia F.
AU - Browne, Teri
AU - Jackson, George L.
AU - Boulware, L. Ebony
AU - Diamantidis, Clarissa
AU - Il'Giovine, Clare
AU - Jackson, George
AU - Pendergast, Jane
AU - Strigo, Tara
AU - Billet, Jon
AU - Browne, Jason
AU - Bucaloiu, Ion
AU - Collins, Charlotte
AU - Davis, Daniel
AU - Fulmer, Sherri
AU - Green, Jamie
AU - Hauer, Chelsie
AU - Richner, Michelle
AU - Siegrist, Cory
AU - Smeal, Wendy
AU - Stametz, Rebecca
AU - Solomon, Mary
AU - Yule, Christina
AU - Ephraim, Patti
AU - Greer, Raquel
AU - Tangri, Navdeep
AU - Bankes, Brian
AU - Bolden, Shakur
AU - Danielson, Patricia
AU - Lang-Lindsey, Katina
AU - Ruff, Suzanne
AU - Schmidt, Lana
AU - Swoboda, Amy
AU - Woods, Peter
AU - Clynes, Diana
AU - Stewart, Stephanie
AU - Schatell, Dori
AU - Klicko, Kristi
AU - Vinson, Brandi
N1 - Publisher Copyright:
© 2020
PY - 2020/9/1
Y1 - 2020/9/1
N2 - 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.
AB - 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.
KW - Chronic kidney disease
KW - fragmented care
KW - nephrology care
KW - patient-centeredness
KW - patient-provider communication
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U2 - 10.1016/j.xkme.2020.05.008
DO - 10.1016/j.xkme.2020.05.008
M3 - Article
C2 - 33089136
AN - SCOPUS:85087790920
SN - 2590-0595
VL - 2
SP - 532-542.e1
JO - Kidney Medicine
JF - Kidney Medicine
IS - 5
ER -