Abstract: FR-PO337
Patients' Reliance on Non-Nephrologists for CKD Treatment and Advice
Session Information
- CKD: Clinical, Outcomes, Trials - II
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Barrett, Tyler M., Duke University, Durham, North Carolina, United States
- Ephraim, Patti, Johns Hopkins University , Baltimore, Maryland, United States
- Green, Jamie Alton, Geisinger Medical Center, Danville, Pennsylvania, United States
- Peskoe, Sarah B., Duke University, Durham, North Carolina, United States
- Pendergast, Jane F., Duke University, Durham, North Carolina, United States
- Hauer, Chelsie, Geisinger Medical Center, Danville, Pennsylvania, United States
- Strigo, Tara Smith, Duke University, Durham, North Carolina, United States
- Hill-Briggs, Felicia, Johns Hopkins University , Baltimore, Maryland, United States
- Browne, Teri, University of South Carolina, Columbia, South Carolina, United States
- Jackson, George L., Durham VA Medical Center, Durham, North Carolina, United States
- Greer, Raquel C., Johns Hopkins University , Baltimore, Maryland, United States
- Diamantidis, Clarissa Jonas, Duke University, Durham, North Carolina, United States
- Boulware, L. Ebony, Duke University, Durham, North Carolina, United States
Background
Chronic kidney disease (CKD) care is often fragmented across multiple health care providers, and it is unclear who patients rely on most.
Methods
We conducted a cross-sectional study of adults receiving nephrology care and enrolled in the PREPARE NOW trial to assess their reliance on their nephrologist, primary care provider (PCP), another specialist, or all their providers equally for CKD treatment and advice. We also asked participants about the frequency and patient-centeredness (range 0 [least] to 12 [most]) of their nephrology care. We assessed participants’ kidney function and comorbidity (Charlson Comorbidity Index, range 0-37) using data from their electronic health records. In multivariable analyses, we quantified associations between participants’ reliance on their nephrologists (vs. others) for their CKD treatment and demographics, comorbidity, kidney function, and perceived patient centeredness for their most recent nephrology visit.
Results
The 453 study participants had a mean (SD) age of 71.2 (12.1) years, 59% were female, 99% were White, and 66% had a high school education or less. Participants had seen nephrology for a median (IQR) of 3.8 (2.0-6.6) years, and 50% saw their nephrologist at least every 6 months. The median (IQR) patient-centeredness score was 11 (9-12). Participants’ mean (SD) eGFR was 33.2 (11.7) mL/min/1.73m2, and their median (IQR) Charlson score was 5 (3-7). Only half (56%) reported they relied primarily on their nephrologist for CKD treatment and advice, while 23% relied on their PCP, 18% relied on all providers equally, and 3% relied on another specialist. After adjustment, participants who saw their nephrologists for longer (OR [95% CI]: 1.09 [1.02-1.17] per additional year, p=0.01) and perceived nephrology visits as more patient centered (OR [95% CI]: 1.31 [1.17-1.47] per unit score increase, p<0.0001) had greater odds of relying mostly on nephrologists for CKD treatment and advice.
Conclusion
Many nephrology patients rely on non-nephrologists for CKD treatment and advice. Establishing longitudinal, patient-centered nephrology care and partnerships with patients’ other physicians may help ensure patients adhere to nephrologists’ CKD treatment and advice.