Visser Annemieke, Dijkstra Geke J, Huisman Roel M, Gansevoort Ron T, de Jong Paul E, Reijneveld Sijmen A
Department of Health Sciences, Northern Centre for Healthcare Research, University Medical Centre Groningen, University of Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands.
Nephrol Dial Transplant. 2007 Nov;22(11):3255-61. doi: 10.1093/ndt/gfm382. Epub 2007 Jun 25.
Incidence of dialysis in elderly patients in the Netherlands is low compared to other countries. This study aims to assess the impact of patients' age and comorbidity on the likelihood of referral and acceptance of patients for dialysis and whether this is affected by physician characteristics.
A vignette study was performed among 209 primary care physicians, 162 non-nephrology specialists and 20 nephrologists working in the north of the Netherlands. Physicians were offered six vignettes concerning case-reports of patients with end-stage renal disease (ESRD) and varying comorbidities or circumstances and asked about the likelihood of referral/acceptance of the patient in the given circumstances.
The likelihood of referral within groups of physicians varied widely, especially within the group of primary care physicians and non-nephrology specialists, but was not affected by characteristics of physicians. The likelihood of referral or acceptance of patients for dialysis depended on the patient's age, and type and severity of comorbidity. In general, primary care physicians and non-nephrology specialists were less likely to refer than nephrologists were to accept. Differences within and between groups of physicians were larger for 80- than for 65-year-old patients, and for patients with less severe shortness of breath and cognitive impairments and more severe diabetes and social impairments. Hardly any differences were found for patients with cancer.
Patients' age and comorbidities affect the likelihood of referral. Differences between groups of physicians suggest that there is insufficient agreement on the extent to which these factors should affect the referral/acceptance of patients for dialysis. These findings underline the need for more research into circumstances under which patients might benefit from dialysis. Guidelines should be developed to improve the referral of elderly and less healthy patients.
与其他国家相比，荷兰老年患者的透析发生率较低。本研究旨在评估患者年龄和合并症对透析转诊可能性及接受度的影响，以及这是否受医生特征的影响。
对荷兰北部的209名初级保健医生、162名非肾病专科医生和20名肾病科医生进行了一项病例 vignette 研究。向医生提供了6个关于终末期肾病（ESRD）患者病例报告的 vignette，这些患者具有不同的合并症或情况，并询问在给定情况下转诊/接受该患者的可能性。
医生群体内部的转诊可能性差异很大，尤其是在初级保健医生和非肾病专科医生群体中，但不受医生特征的影响。患者透析转诊或接受的可能性取决于患者的年龄、合并症的类型和严重程度。一般来说，初级保健医生和非肾病专科医生转诊的可能性低于肾病科医生接受的可能性。对于80岁患者而非65岁患者，以及呼吸急促和认知障碍较轻、糖尿病和社会功能障碍较严重的患者，医生群体内部和之间的差异更大。对于癌症患者几乎没有发现差异。
患者的年龄和合并症影响转诊可能性。医生群体之间的差异表明，对于这些因素应在多大程度上影响患者透析转诊/接受度，尚未达成足够的共识。这些发现强调需要对患者可能从透析中获益的情况进行更多研究。应制定指南以改善老年和健康状况较差患者的转诊。
Zotero 插件