University of Maryland School of Medicine, Medical Systems, 22 South Greene Street, Room N3W143, Baltimore, MD 21201, USA.
Clin J Am Soc Nephrol. 2011 Feb;6(2):334-43. doi: 10.2215/CJN.06240710. Epub 2011 Jan 6.
Collaboration between primary care physicians (PCPs) and nephrologists in the care of patients with chronic kidney disease (CKD) is widely advocated, but physician preferences regarding collaboration are unknown. Physicians' desires to collaborate in the care of a hypothetical patient with CKD, their preferred content of collaboration, and their perceived barriers to collaboration were assessed.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A questionnaire describing the care of a hypothetical patient with progressive CKD was administered to a national sample of U.S. PCPs and nephrologists. Physician characteristics and attitudes associated with desires to collaborate were identified.
Among 124 PCPs and 120 nephrologists, most physicians (85% PCPs versus 94% nephrologists) desired collaboration. Nephrologists were more likely than PCPs to prefer collaboration focus on predialysis/renal replacement therapy preparation and electrolyte management (73% versus 52% and 81% versus 46%, respectively). PCPs were more likely to desire collaboration if the hypothetical patient had diabetes and hypertension (versus hypertension alone), if they believed the care they provide helps slow CKD disease progression, and if they did not perceive health insurance as a barrier to nephrology referral (adjusted percentages [95% confidence interval]: 94% [80 to 98] versus 75% [reference]), 92% [75 to 98] versus 75% [reference], 42% [9 to 85] versus 88% [reference], respectively).
Most PCPs and nephrologists favored collaborative care for a patient with progressive CKD, but their preferred content of collaboration differed. Collaborative models that explicitly include PCPs in the care of patients with CKD may help improve patients' clinical outcomes.
初级保健医生（PCP）与肾病医生在慢性肾脏病（CKD）患者的治疗中合作得到广泛提倡，但医生对合作的偏好尚不清楚。评估了医生对患有 CKD 的假设患者进行合作护理的愿望、他们对合作内容的偏好以及他们认为的合作障碍。
设计、设置、参与者和测量：向美国全国范围内的 PCP 和肾病医生样本发放了一份描述假设 CKD 患者护理的问卷。确定了与合作愿望相关的医生特征和态度。
在 124 名 PCP 和 120 名肾病医生中，大多数医生（85%的 PCP 与 94%的肾病医生）希望合作。与 PCP 相比，肾病医生更倾向于合作重点放在透析前/肾脏替代治疗准备和电解质管理上（分别为 73%与 52%和 81%与 46%）。如果假设患者患有糖尿病和高血压（而非高血压）、如果他们认为自己提供的护理有助于减缓 CKD 疾病进展、并且如果他们不认为健康保险是肾病学转诊的障碍（调整后的百分比[95%置信区间]：94%[80 至 98]与 75%[参考]、92%[75 至 98]与 75%[参考]、42%[9 至 85]与 88%[参考]），那么 PCP 更有可能希望合作。
大多数 PCP 和肾病医生都赞成对进展性 CKD 患者进行协作护理，但他们对合作内容的偏好不同。明确将 PCP 纳入 CKD 患者护理的协作模式可能有助于改善患者的临床结局。
