Division of General Internal Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Baltimore, MD 21287, USA.
Am J Kidney Dis. 2011 Apr;57(4):583-91. doi: 10.1053/j.ajkd.2010.08.027. Epub 2010 Dec 4.
The quality of patient-physician discussions about chronic kidney disease (CKD) in primary care has not been studied previously.
Cross-sectional study.
SETTINGS & PARTICIPANTS: We audiotaped encounters between 236 patients with hypertension and their primary care physicians (n = 40).
Patient, physician, and encounter characteristics.
OUTCOMES & MEASUREMENTS: We described the occurrence and characteristics (content, use of technical terms, and physician assessment of patient comprehension of new concepts) of CKD discussions. We assessed patient and physician characteristics associated with CKD discussion occurrence.
Many patients (mean age, 59 years) had uncontrolled hypertension (51%), diabetes (44%), and/or 3 or more comorbid conditions (51%). Most primary care physicians practiced (52%) fewer than 10 years. CKD discussions occurred in few (26%; n = 61) encounters, with content focused on laboratory assessment (89%), risk-factor treatment (28%), and causes (26%) of CKD. In encounters that included a CKD discussion, physicians used technical terms (28%; n = 17) and rarely assessed patients' comprehension (2%; n = 1). CKD discussions were statistically significantly less common in visits of patients with some (vs no) college education (OR, 0.23; 95% CI, 0.09-0.56), with 3 or more (vs fewer) comorbid conditions (OR, 0.49; 95% CI, 0.25-0.96), and who saw physicians with more (vs fewer) than 10 years of practice experience (OR, 0.41; 95% CI, 0.21-0.80). CKD discussions were more common during longer encounters (OR, 1.31; 95% CI, 1.04-1.65) and encounters in which diabetes was (vs was not) discussed (OR, 2.87; 95% CI, 1.22-6.77).
Generalizability of our findings may be limited.
Patient-physician discussions about CKD in high-risk primary care patients were infrequent. Physicians used technical terms and infrequently assessed patients' understanding of new CKD concepts. Efforts to improve the frequency and content of patient-physician CKD discussions in primary care could improve patients' clinical outcomes.
此前尚未研究初级保健中患者与医生就慢性肾脏病（CKD）进行讨论的质量。
横断面研究。
我们对 236 名高血压患者及其初级保健医生（n=40）之间的 40 次就诊进行了录音。
患者、医生和就诊特征。
许多患者（平均年龄 59 岁）患有未得到控制的高血压（51%）、糖尿病（44%）和/或 3 种或更多合并症（51%）。大多数初级保健医生的从业年限不足 10 年（52%）。只有少数（26%；n=61）就诊时进行了 CKD 讨论，内容集中在实验室评估（89%）、危险因素治疗（28%）和 CKD 的病因（26%）。在包括 CKD 讨论的就诊中，医生使用了专业术语（28%；n=17），很少评估患者的理解程度（2%；n=1）。在受教育程度（与无受教育程度相比，OR，0.23；95%CI，0.09-0.56）、合并症数量（与少于 3 种相比，OR，0.49；95%CI，0.25-0.96）或医生从业年限（与少于 10 年相比，OR，0.41；95%CI，0.21-0.80）不同的就诊中，CKD 讨论更常见。较长的就诊时间（OR，1.31；95%CI，1.04-1.65）和就诊时讨论了糖尿病（与未讨论相比，OR，2.87；95%CI，1.22-6.77）会使 CKD 讨论更常见。
我们研究结果的推广可能会受到限制。
在高风险的初级保健患者中，患者与医生就 CKD 进行的讨论很少。医生使用专业术语，且很少评估患者对新 CKD 概念的理解。努力提高初级保健中患者与医生进行 CKD 讨论的频率和内容可以改善患者的临床结局。
