For CKD Care, PCPs and Nephrologists Support Collaborative Approach

Hogan, Michelle

doi: 10.1097/01.NEP.0000394222.78600.24
In Brief

Most primary care physicians and nephrologists favor collaborative care for patients with progressive chronic kidney disease (CKD), even if they may disagree on some of the specifics, according to results of a survey study published early online by the Clinical Journal of the American Society of Nephrology.

As part of a national study of physicians’ recognition of CKD and attitudes toward care, Clarissa Jonas Diamantidis, MD, MHS, of the Division of Nephrology at the University of Maryland School of Medicine, and colleagues sent a questionnaire describing the care of a hypothetical patient with progressive CKD to a national sample of primary care physicians and nephrologists.

Of 959 eligible physicians, 304 responded, 244 of whom recommended nephrology referral and answered the collaborative care question, and are thus included in this analysis (124 primary care physicians and 120 nephrologists).

While collaborative care was favored by most physicians, statistically significantly more nephrologists than primary care physicians reported a preference for this approach—94% versus 85%.

Seventy-three percent of nephrologists leaned more toward collaboration focused on preparing patients for dialysis or kidney transplantation, compared with 52% of primary care physicians, and 81% preferred care that focused on electrolyte management, versus 46% of primary care physicians. About half of kidney specialists said patients are referred too late.

Primary care physicians, on the other hand, were more likely to favor collaborative care if the hypothetical patient had both diabetes and hypertension versus hypertension alone, and if they believed the care they would provide would assist in slowing disease progression. At the same time, they were less likely to prefer shared care if they felt insurance restrictions limited their ability to refer patients to nephrologists.

“Collaborative models that explicitly include PCPs in CKD care and that specify the roles of PCPs and nephrologists in addressing the needs of patients may improve the quality of patients’ care and clinical outcomes,” Dr. Diamantidis and colleagues wrote.

© 2011 Lippincott Williams & Wilkins, Inc.