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

Publication ,  Journal Article
Barrett, TM; Green, JA; Greer, RC; Ephraim, PL; Peskoe, S; Pendergast, JF; Hauer, CL; Strigo, TS; Norfolk, E; Bucaloiu, ID; Diamantidis, CJ ...
Published in: Kidney Med
2020

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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Published In

Kidney Med

DOI

EISSN

2590-0595

Publication Date

2020

Volume

2

Issue

5

Start / End Page

532 / 542.e1

Location

United States

Related Subject Headings

  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Barrett, T. M., Green, J. A., Greer, R. C., Ephraim, P. L., Peskoe, S., Pendergast, J. F., … PREPARE NOW study investigators, . (2020). Advanced CKD Care and Decision Making: Which Health Care Professionals Do Patients Rely on for CKD Treatment and Advice? Kidney Med, 2(5), 532-542.e1. https://doi.org/10.1016/j.xkme.2020.05.008
Barrett, Tyler M., Jamie A. Green, Raquel C. Greer, Patti L. Ephraim, Sarah Peskoe, Jane F. Pendergast, Chelsie L. Hauer, et al. “Advanced CKD Care and Decision Making: Which Health Care Professionals Do Patients Rely on for CKD Treatment and Advice?Kidney Med 2, no. 5 (2020): 532-542.e1. https://doi.org/10.1016/j.xkme.2020.05.008.
Barrett TM, Green JA, Greer RC, Ephraim PL, Peskoe S, Pendergast JF, et al. Advanced CKD Care and Decision Making: Which Health Care Professionals Do Patients Rely on for CKD Treatment and Advice? Kidney Med. 2020;2(5):532-542.e1.
Barrett, Tyler M., et al. “Advanced CKD Care and Decision Making: Which Health Care Professionals Do Patients Rely on for CKD Treatment and Advice?Kidney Med, vol. 2, no. 5, 2020, pp. 532-542.e1. Pubmed, doi:10.1016/j.xkme.2020.05.008.
Barrett TM, Green JA, Greer RC, Ephraim PL, Peskoe S, Pendergast JF, Hauer CL, Strigo TS, Norfolk E, Bucaloiu ID, Diamantidis CJ, Hill-Briggs FF, Browne T, Jackson GL, Boulware LE, PREPARE NOW study investigators. Advanced CKD Care and Decision Making: Which Health Care Professionals Do Patients Rely on for CKD Treatment and Advice? Kidney Med. 2020;2(5):532-542.e1.
Journal cover image

Published In

Kidney Med

DOI

EISSN

2590-0595

Publication Date

2020

Volume

2

Issue

5

Start / End Page

532 / 542.e1

Location

United States

Related Subject Headings

  • 3202 Clinical sciences