Older patients with advanced CKD may benefit from multidisciplinary clinics
Click Here to Manage Email Alerts
Compared with general nephrology care, more vulnerable patients, such as older adults with advanced chronic kidney disease, may benefit more from multidisciplinary care, according to data published in Kidney Medicine.
Further, multidisciplinary care may be associated with more equitable care given the results of this study.
“There is growing research exploring the role that multidisciplinary care may play in health care delivery and outcomes across medicine,” Surekha Annadanam, MD, from the University of Michigan, told Healio. “Supported by work led by [Julie] Wright Nunes, [MD] with funding via the NIH [National Institute of Diabetes and Digestive and Kidney Diseases] NIDDK, our goal was to better understand the potential impact of multidisciplinary nephrology care on selected patient-reported outcomes, in comparison to a general nephrology care.”
Study design
In the cross-sectional study, Annadanam and colleagues examined 245 patients (mean age was 60 years; 48% were men; 49% were women; 3% were transgender/no response/other) with stage 1 to 5 CKD. None of the patients had received a transplant or were on dialysis.
While patients receiving general nephrology care (n=168) were limited to only seeing a nephrologist in this study, patients receiving multidisciplinary care (n=77) were seen by a pharmacist, social worker, dietitian and a nephrologist.
Following care visits, patients completed a validated survey to measure their kidney disease knowledge. Survey responses were scored on a scale of 0% to 100% based on correct answers.
“We specifically studied the effect on four patient-centered outcomes: CKD-specific knowledge, kidney disease-related stress, perception of overall health and perception of health status compared to 1 year ago,” Annadanam said.
Using a Welch-2-sample t-test and linear regression model, researchers identified differences among the patient groups.
Results
Analyses revealed patients in multidisciplinary care programs were, on average, older than those receiving general nephrology care (64 years vs. 58 years) and had more advanced kidney disease (66% had stage 4 to 5 CKD vs. 36%).
“We did not observe significant differences in outcomes between those receiving multidisciplinary care vs. those receiving general nephrology care, which was somewhat surprising. However, patients cared for by design of the multidisciplinary clinics, were older and had more advanced CKD,” Annadanam said. “Our results do leave consideration that a team-based approach may be associated with more equitable care, because outcomes were the same in both groups despite differences in age and disease severity. This was a cross-sectional study, and there are interpretation limitations that go with this. Thus, we hope future research will explore these associations further.”
Some limitations of the study include assessing CKD knowledge by asking patients their CKD stage instead of eGFR and enrolling patients from a convenience sample. Because the study was conducted at clinics within 30 miles of each other, there is also a possibility of limited generalizability.
“Our study suggests that multidisciplinary clinics may be able to provide more equitable care in terms of achieving some patient-centered outcomes for more vulnerable populations, specifically those who are older or who have more advanced CKD,” Annadanam concluded. “As with prior work of Dr. Wright Nunes and her team, this study also showed that the stress patients feel about their CKD diagnosis may differ by age and race. These findings are important as we look to develop individually tailored education for patients. Additionally, our study highlights an opportunity for continued focus on educating patients about their diagnosis, given most patients within both care models were unable to identify the level of their CKD severity accurately.”
Collapse
Read more about
Click Here to Manage Email Alerts