TY - JOUR
T1 - Quality of patient-physician discussions about CKD in primary care
T2 - A cross-sectional study
AU - Greer, Raquel C.
AU - Cooper, Lisa A.
AU - Crews, Deidra C.
AU - Powe, Neil R.
AU - Boulware, L. Ebony
N1 - Funding Information:
Support: Dr Cooper was supported by grants R01HL069403 and K24HL083113 from the National Heart Lung and Blood Institute and Contract 200609197 from Amgen; Dr Greer, by a National Research Service Award (5 T32 HL007180) and Research Supplement to Promote Diversity in Health-Related Research (grant R01DK079682 ) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); Dr Crews, by Amos Medical Faculty Development Award of the Robert Wood Johnson Foundation; Dr Boulware, by grant K23DK070757 from the National Center for Minority Health and Health Disparities and the NIDDK and contract 200609197 from Amgen; Dr Powe, by grant K240502643 from NIDDK and Foundation for Informed Medical Decision Making .
PY - 2011/4
Y1 - 2011/4
N2 - Background The quality of patient-physician discussions about chronic kidney disease (CKD) in primary care has not been studied previously. Study Design Cross-sectional study. Settings & Participants We audiotaped encounters between 236 patients with hypertension and their primary care physicians (n = 40). Predictors Patient, physician, and encounter characteristics. Outcomes & Measurements We described the occurrence and characteristics (content, use of technical terms, and physician assessment of patient comprehension of new concepts) of CKD discussions. We assessed patient and physician characteristics associated with CKD discussion occurrence. Results Many patients (mean age, 59 years) had uncontrolled hypertension (51%), diabetes (44%), and/or 3 or more comorbid conditions (51%). Most primary care physicians practiced (52%) fewer than 10 years. CKD discussions occurred in few (26%; n = 61) encounters, with content focused on laboratory assessment (89%), risk-factor treatment (28%), and causes (26%) of CKD. In encounters that included a CKD discussion, physicians used technical terms (28%; n = 17) and rarely assessed patients' comprehension (2%; n = 1). CKD discussions were statistically significantly less common in visits of patients with some (vs no) college education (OR, 0.23; 95% CI, 0.09-0.56), with 3 or more (vs fewer) comorbid conditions (OR, 0.49; 95% CI, 0.25-0.96), and who saw physicians with more (vs fewer) than 10 years of practice experience (OR, 0.41; 95% CI, 0.21-0.80). CKD discussions were more common during longer encounters (OR, 1.31; 95% CI, 1.04-1.65) and encounters in which diabetes was (vs was not) discussed (OR, 2.87; 95% CI, 1.22-6.77). Limitations Generalizability of our findings may be limited. Conclusions Patient-physician discussions about CKD in high-risk primary care patients were infrequent. Physicians used technical terms and infrequently assessed patients' understanding of new CKD concepts. Efforts to improve the frequency and content of patient-physician CKD discussions in primary care could improve patients' clinical outcomes.
AB - Background The quality of patient-physician discussions about chronic kidney disease (CKD) in primary care has not been studied previously. Study Design Cross-sectional study. Settings & Participants We audiotaped encounters between 236 patients with hypertension and their primary care physicians (n = 40). Predictors Patient, physician, and encounter characteristics. Outcomes & Measurements We described the occurrence and characteristics (content, use of technical terms, and physician assessment of patient comprehension of new concepts) of CKD discussions. We assessed patient and physician characteristics associated with CKD discussion occurrence. Results Many patients (mean age, 59 years) had uncontrolled hypertension (51%), diabetes (44%), and/or 3 or more comorbid conditions (51%). Most primary care physicians practiced (52%) fewer than 10 years. CKD discussions occurred in few (26%; n = 61) encounters, with content focused on laboratory assessment (89%), risk-factor treatment (28%), and causes (26%) of CKD. In encounters that included a CKD discussion, physicians used technical terms (28%; n = 17) and rarely assessed patients' comprehension (2%; n = 1). CKD discussions were statistically significantly less common in visits of patients with some (vs no) college education (OR, 0.23; 95% CI, 0.09-0.56), with 3 or more (vs fewer) comorbid conditions (OR, 0.49; 95% CI, 0.25-0.96), and who saw physicians with more (vs fewer) than 10 years of practice experience (OR, 0.41; 95% CI, 0.21-0.80). CKD discussions were more common during longer encounters (OR, 1.31; 95% CI, 1.04-1.65) and encounters in which diabetes was (vs was not) discussed (OR, 2.87; 95% CI, 1.22-6.77). Limitations Generalizability of our findings may be limited. Conclusions Patient-physician discussions about CKD in high-risk primary care patients were infrequent. Physicians used technical terms and infrequently assessed patients' understanding of new CKD concepts. Efforts to improve the frequency and content of patient-physician CKD discussions in primary care could improve patients' clinical outcomes.
KW - Chronic kidney disease
KW - patient awareness
KW - patient-physician communication
KW - primary care
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U2 - 10.1053/j.ajkd.2010.08.027
DO - 10.1053/j.ajkd.2010.08.027
M3 - Article
C2 - 21131116
AN - SCOPUS:79952985822
VL - 57
SP - 583
EP - 591
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 4
ER -