Israni Rubeen K, Shea Judy A, Joffe Marshall M, Feldman Harold I
Renal and Hypertension Division, Department of Medicine, Christiana Care Health System, Newark, DE, USA.
Am J Kidney Dis. 2009 Aug;54(2):238-47. doi: 10.1053/j.ajkd.2009.01.258. Epub 2009 Apr 9.
Many studies suggest that chronic kidney disease (CKD) care is suboptimal in the United States. However, it is not known whether knowledge of CKD management in primary care physicians (PCPs) might have an important role in the suboptimal care and whether PCP characteristics are associated with having adequate knowledge.
Cross-sectional study.
SETTING & PARTICIPANTS: Self-administered questionnaire sent to a random sample of 1,550 US PCPs in February 2007.
PCP characteristics, including age, sex, degree (MD versus DO), primary specialty, board certification, patient volume, percentage of time in patient care spent in the inpatient versus outpatient setting, and number of patients referred to nephrologists in a month.
OUTCOMES & MEASUREMENTS: Regression analyses of the association between physician characteristics and overall physician knowledge of CKD management, as well as individual subdomains of CKD knowledge related to recognition of CKD and management of hypertension in the setting of CKD.
470 of 1,453 (32.4%) eligible PCPs returned a completed survey. PCPs show significant variation in their ability to recognize CKD stages 2 to 4, but most have appropriate blood pressure goals in patients with CKD and are knowledgeable of the role of angiotensin-converting enzyme inhibitors in managing proteinuria. For each 10-year increase in age, the odds of showing satisfactory knowledge of CKD management decreased by 26% (odds ratio, 0.74; 95% confidence interval, 0.60 to 0.92). PCPs with the primary specialty of internal medicine had a more than 3-fold greater odds of showing a satisfactory level of knowledge compared with family practice specialists (odds ratio, 3.40; 95% confidence interval, 2.17 to 5.32).
The study findings are limited by the potential presence of nonresponse bias, information bias, and results suggesting there are multiple knowledge subdomains that perhaps are not additive.
There is need to improve CKD knowledge in PCPs, especially regarding recognition of CKD at an early stage.
许多研究表明，美国慢性肾脏病（CKD）的护理并不理想。然而，尚不清楚初级保健医生（PCP）对CKD管理的了解是否在这种不理想的护理中发挥重要作用，以及PCP的特征是否与具备足够的知识相关。
横断面研究。
2007年2月向1550名美国PCP的随机样本发送了自填式问卷。
PCP的特征，包括年龄、性别、学位（医学博士与医学博士）、主要专业、委员会认证、患者数量、在住院与门诊环境中用于患者护理的时间百分比，以及一个月内转诊至肾病科医生的患者数量。
对医生特征与医生对CKD管理的总体知识之间的关联进行回归分析，以及与CKD识别和CKD背景下高血压管理相关的CKD知识的各个子领域。
1453名符合条件的PCP中有470名（32.4%）返回了完整的调查问卷。PCP在识别CKD 2至4期的能力上存在显著差异，但大多数PCP对CKD患者有适当的血压目标，并且了解血管紧张素转换酶抑制剂在管理蛋白尿中的作用。年龄每增加10岁，对CKD管理表现出满意知识的几率降低26%（优势比，0.74；95%置信区间，0.60至0.92）。与家庭医学专科医生相比，主要专业为内科的PCP表现出满意知识水平的几率高出3倍多（优势比，3.40；95%置信区间，2.17至5.32）。
研究结果受到无应答偏倚、信息偏倚的潜在影响，并且结果表明存在多个可能不具有累加性的知识子领域。
需要提高PCP对CKD的知识，尤其是在早期识别CKD方面。
