Many patients with CKD do not rely on nephrologists for treatment, advice
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A study conducted in Pennsylvania revealed that many adults with chronic kidney disease utilized medical health care professionals other than nephrologists for related treatment and advice.
Tyler M. Barrett, MA, of Duke University School of Medicine, and colleagues suggested that implementation of more patient-centric models of care could increase reliance on nephrologists as the primary source for kidney disease management, thereby potentially improving outcomes.
“Patients with chronic kidney disease (CKD) often have multiple comorbidities, requiring them to interact with nephrologists, as well as non-nephrologist health care providers,” the researchers wrote. “As a result, CKD care can be fragmented, and patients may receive conflicting treatment information.”
Furthermore, they contended that previous studies have demonstrated that non-nephrologist providers may have limited knowledge of the disease, leading to challenges in following CKD clinical practice guidelines. Several barriers to the successful co-management of patients have also been identified by both primary care physicians and nephrologists.
To explore potential causes and factors as to why patients might choose a specific type of health care professional for their kidney disease, Barrett and colleagues considered 453 patients receiving care at one of Geisinger Health System’s outpatient nephrology clinics. All patients had advanced kidney disease but had not yet started renal replacement therapy (mean age, 71 years; 97% were white patients). Researchers noted study patients were under the care of approximately 235 primary care physicians, who “do not receive system-wide CKD training at Geisinger other than best practice alerts.”
Electronic health records were used to determine patient-specific information, with patients also reporting the frequency of their nephrology care, which medical health care professional(s) they most relied on and their perspectives on nephrology care received.
Reports showed patients were in nephrology care for a median of 3.8 years and had completed a median of four nephrology appointments in the past 2 years.
Half of patients (56%) relied primarily on their nephrologists, 23% relied on PCPs, 18% relied on all providers equally and 3% relied on other specialists.
Researchers found the adjusted odds of relying on nephrologists were higher for those in nephrology care for longer (odds ratio = 1.08), those who completed more nephrology visits in the previous 2 years (OR = 1.16) and those who perceived their last interaction with a nephrologist as more patient-centered (OR = 2.63).
Perception of patient-centered care was assessed using the patient perception of patient centeredness scale, in which patients reported how well problems were discussed at their last visit, whether the nephrologist was aware of the primary reason for the visit, if the patient felt the nephrologist understood them and how much they thought the nephrologist cared about them personally.
According to the researchers, the observed importance of patient-centered care may point to the long-term relationships patients frequently develop with their PCPs, as they see these medical health care professionals for a variety of conditions and in the early stages of CKD (before a nephrologist appointment becomes necessary).
In addition to improving co-management strategies, the researchers emphasized that nephrologists must prioritize building relationships with their patients.
“It may take time for patients to cultivate the type of trusting relationship with their nephrologists that they may already have with their PCPs, and our findings suggest that efforts to establish this relationship earlier may help patients prioritize the CKD treatment and advice they receive from their nephrologists,” they wrote.
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