Primary Care-Specialist Collaboration in the Care of Patients with Chronic Kidney Disease

Diamantidis, Clarissa J.; Powe, Neil R.; Jaar, Bernard G.; Greer, Raquel C.; Troll, Misty U.; Boulware, L. Ebony

doi:10.2215/cjn.06240710

Cited by 54 publications

(39 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These observations may reflect patterns of nephrologist referral by primary care physicians that may vary depending on their self-efficacy in managing CKD, interaction with nephrologists, and perceived patient barriers to health care access. 18–20 Nephrologist care is strongly recommended for all patients with CKD stages 4–5 because early nephrology referral is associated with reduced morbidity and mortality when dialysis therapy is started, 21 but not all patients with CKD stage 3 need to be seen by a nephrologist, especially those without proteinuria or at low risk of progression (eg, eGFR consistently >45 mL/min/1.73 m 2 ). 22 In our cohort, rates of nephrology visits were lower than reported elsewhere, 23 which may be explained in part by study design.…”

Section: Discussionmentioning

confidence: 99%

Access to Health Care Among Adults Evaluated for CKD: Findings From the Kidney Early Evaluation Program (KEEP)

Agrawal

Jaar

Frisby

et al. 2012

American Journal of Kidney Diseases

Self Cite

View full text Add to dashboard Cite

Background Data are scant regarding access to health care in patients with chronic kidney disease (CKD). We performed descriptive analyses using data from the National Kidney Foundation’s Kidney Early Evaluation Program (KEEP), a nationwide health screening program for adults at high risk of CKD. Methods From 2000–2010, a total of 122,502 adults without end-stage renal disease completed KEEP screenings; 27,927 (22.8%) met criteria for CKD (10,082, stages 1–2; 16,684, stage 3; and 1,161, stages 4–5). CKD awareness, self-rated health status, frequency of physician visits, difficulty obtaining medical care, types of caregivers, insurance status, and medication coverage and estimated costs were assessed. Results Participants with CKD were more likely to report fair/poor health status than those without CKD. Health care utilization increased at later CKD stages; ~95% of participants at stages 3–5 had visited a physician during the preceding year compared with 83.7% of participants without CKD. More Hispanic and African American than white participants at all CKD stages reported not having a physician. Approximately 40% of participants younger than 65 years reported fair/poor health status at stages 4–5 compared with ~30% who were 65 years and older. Younger participants at all stages were more likely to report extreme or somewhat/moderate difficulty obtaining medical care. Comorbid conditions (diabetes, hypertension, and prior cardiovascular events) were associated with increased utilization of care. Utilization of nephrology care was poor at all CKD stages; <6% of participants at stage 3 and <30% at stages 4–5 reported ever seeing a nephrologist. Conclusions Lack of health insurance and perceived difficulty obtaining medical care with lower health care utilization, both of which are consistent with inadequate access to health care, are more likely for KEEP participants who are younger than 65 years, nonwhite, and without previously diagnosed comorbid conditions. Nephrology care is infrequent in elderly participants with advanced CKD who are nonwhite, have comorbid disease, and have high-risk states for cardiovascular disease.

show abstract

Section: Discussionmentioning

confidence: 99%

Access to Health Care Among Adults Evaluated for CKD: Findings From the Kidney Early Evaluation Program (KEEP)

Agrawal

Jaar

Frisby

et al. 2012

American Journal of Kidney Diseases

Self Cite

View full text Add to dashboard Cite

show abstract

“…This helps translate research results to clinical care, lowering well known barriers to the implementation of existing practice guidelines for care of patients with CKD. 27,28 The majority of CKD patients are cared for by primary care providers with or without collaboration with nephrologists, 8,29 and PCTs may be well positioned to affect CKD care in the primary care setting. Examples of studies bridging nephrology and primary care include trials of CKD care coordination with patient navigators 30 and strategies to implement guidelineconcordant CKD care with electronic checklists, 31 primary care practice facilitation, 32 and pharmacist-led interventions.…”

Section: Potential Benefits Of Pct Designs In Ckdmentioning

confidence: 99%

Pragmatic Clinical Trials in CKD: Opportunities and Challenges

Boer

Kövesdy

Navaneethan

et al. 2016

JASN

View full text Add to dashboard Cite

Randomized controlled trials in CKD lag in number behind those of other chronic diseases, despite the high morbidity and mortality experienced by patients with kidney disease and the exorbitant costs of their health care. Observational studies of CKD frequently yield seemingly paradoxic associations of traditional risk factors with outcomes, making it difficult to extrapolate the results of trials conducted in people with normal kidney function to patients with CKD. However, many completed trials in CKD have been limited by intermediate outcomes of unclear clinical significance or narrow eligibility criteria that limit external validity, and implementation of proven therapies remains a challenge. It is therefore imperative that the nephrology community capitalize on recent interest in novel approaches to trial design, such as pragmatic clinical trials. These trials are meant to promote research within real world settings to yield clinically relevant results with greater applicability than those of traditional trials, while maintaining many advantages, such as controlling for potential sources of bias. We provide a description of pragmatic clinical trials and a discussion of advantages, disadvantages, and practical challenges inherent to this study design, in the context of specific scientific questions relevant to patients with CKD.

show abstract

“…26 A subsequent study showed that primary care physicians with more than 10 years in practice were least likely to recommend referral of patients with CKD but more likely to express a desire for collaborative care, yet the differences were small (89% vs 82%). 27,28 General internists who were aware of existing guidelines were 14 times more likely to recommend referral. 27 …”

Section: Discussionmentioning

confidence: 99%

Physician Utilization, Risk-Factor Control, and CKD Progression Among Participants in the Kidney Early Evaluation Program (KEEP)

Jurkovitz

Elliott

et al. 2012

American Journal of Kidney Diseases

View full text Add to dashboard Cite

Background Chronic kidney disease (CKD) is a well-known risk factor for cardiovascular mortality, but little is known about the association between physician utilization and cardiovascular disease risk-factor control in patients with CKD. We used 2005–2010 data from the National Kidney Foundation’s Kidney Early Evaluation Program (KEEP) to examine this association at first and subsequent screenings. Methods Control of risk factors was defined as control of blood pressure, glycemia, and cholesterol levels. We used multinomial logistic regression to examine the association between participant characteristics and seeing a nephrologist after adjusting for kidney function and paired t tests or McNemar tests to compare characteristics at first and second screenings. Results Of 90,009 participants, 61.3% had a primary care physician only, 2.9% had seen a nephrologist, and 15.3% had seen another specialist. The presence of 3 risk factors (hypertension, diabetes, and hypercholesterolemia) increased from 26.8% in participants with CKD stages 1–2 to 31.9% in those with stages 4–5. Target levels of all risk factors were achieved in 7.2% of participants without a physician, 8.3% of those with a primary care physician only, 9.9% of those with a nephrologist, and 10.3% of those with another specialist. Of up to 7,025 participants who met at least one criterion for nephrology consultation at first screening, only 12.3% reported seeing a nephrologist. Insurance coverage was associated strongly with seeing a nephrologist. Of participants who met criteria for nephrology consultation, 406 (5.8%) returned for a second screening, of whom 19.7% saw a nephrologist. The percentage of participants with all risk factors controlled was higher at the second screening (20.9% vs 13.3%). Conclusion Control of cardiovascular risk factors is poor in the KEEP population. The percentage of participants seeing a nephrologist is low, although better after the first screening. Identifying communication barriers between nephrologists and primary care physicians may be a new focus for KEEP.

show abstract

Primary Care-Specialist Collaboration in the Care of Patients with Chronic Kidney Disease

Cited by 54 publications

References 24 publications

Access to Health Care Among Adults Evaluated for CKD: Findings From the Kidney Early Evaluation Program (KEEP)

Access to Health Care Among Adults Evaluated for CKD: Findings From the Kidney Early Evaluation Program (KEEP)

Pragmatic Clinical Trials in CKD: Opportunities and Challenges

Physician Utilization, Risk-Factor Control, and CKD Progression Among Participants in the Kidney Early Evaluation Program (KEEP)

Contact Info

Product

Resources

About