Zhao Yongming, Brooks John M, Flanigan Michael J, Chrischilles Elizabeth A, Pendergast Jane F, Hunsicker Lawrence G
DxCG Inc., Boston, Massachusetts 02110, USA.
Kidney Int. 2008 Dec;74(12):1596-602. doi: 10.1038/ki.2008.212. Epub 2008 May 28.
Early nephrology care may improve treatment outcomes of patients with end-stage renal disease. We sought to examine if physician access affects early nephrology care defined as visiting a nephrologist 12 to 4 months before initiating dialysis. The study population consisted of elderly patients starting hemodialysis whose demographic characteristics and initial dialysis therapy were derived from form 2728 files of the Centers for Medicare & Medicaid Services. Early nephrology care, chronic kidney disease and co-morbidities along with access to local non-nephrologist physicians and nephrologists were identified based on Medicare claims and/or United States 2000 Census data. About one-third of elderly patients received early nephrology care prior to initiating dialysis. Patients living in an area with a large number of non-nephrologist physicians or living relatively far away from a nephrologist had a lower likelihood of getting early nephrology care prior to initiating dialysis while those in an area with more practicing nephrologists were more likely to get early nephrology care. The study shows that physician access significantly influences the use of early nephrology care among elderly patients progressing to end-stage renal disease in the United States.
早期肾病护理可能会改善终末期肾病患者的治疗效果。我们试图研究医生可及性是否会影响早期肾病护理，早期肾病护理定义为在开始透析前12至4个月就诊于肾病专科医生。研究人群包括开始进行血液透析的老年患者，其人口统计学特征和初始透析治疗数据来自医疗保险和医疗补助服务中心的2728表格档案。根据医疗保险理赔记录和/或美国2000年人口普查数据，确定早期肾病护理、慢性肾病和合并症以及当地非肾病专科医生和肾病专科医生的可及性。约三分之一的老年患者在开始透析前接受了早期肾病护理。居住在非肾病专科医生数量较多地区或距离肾病专科医生相对较远的患者，在开始透析前接受早期肾病护理的可能性较低，而居住在肾病专科医生较多地区的患者更有可能接受早期肾病护理。该研究表明，在美国，医生可及性显著影响进展至终末期肾病的老年患者对早期肾病护理的利用。
