Dimitrov Yves, Hannedouche Thierry, Chantrel François, Ott Julien, Kribs Marc, Klein Alexandre, Imhoff Olivier, Krummel Thierry
Service de néphrologie, centre hospitalier d'Haguenau, 64, avenue du Professeur-Leriche, 67500 Haguenau, France.
Service de néphrologie, CHU de Strasbourg, 1, place de l'hôpital, 67000 Strasbourg, France.
Nephrol Ther. 2018 Jun;14(4):217-221. doi: 10.1016/j.nephro.2017.11.001. Epub 2017 Dec 29.
The relationship between specialist physician and primary care physician (PCP) has been poorly evaluated in France. We have studied the application of a specialist's recommendation by the PCP. Vaccination against hepatitis B in patients with chronic renal failure was the follow-up marker. After consultation, the nephrologist wrote in his report to the PCP that the vaccination was recommended. At the next nephrological consultation, the patient was asked if the PCP had proposed vaccination. The clinical, biological characteristics and history of the patients were recorded as well as number and location of the PCP consultations. Five nephrology centers recruited 315 patients. In 61.6% (194/315) of the cases, the vaccination was not proposed by the PCP. Only the estimated GFR (lowest in vaccinated patients, 29.5 vs. 34.5mL/min/1.73m), the delay between the two consultations of the nephrologist (shorter in vaccinated patients, 18.7 vs. 22.9 weeks) and the nephrologist's practice center (17.5 to 52% vaccination rate) are statistically significant in univariate analysis. In multivariate analysis, only the center effect persists. The lack of vaccination was argued by a letter from the PCP in 2 cases (1%). In the absence of a direct questioning of the PCP, the reasons for not following the recommendation remain unexplained. Overall, the recommendation of the nephrologist was little followed. Our study can contribute to the reflection on the shared follow-up of patients suffering from chronic diseases.
在法国，专科医生与初级保健医生（PCP）之间的关系尚未得到充分评估。我们研究了初级保健医生对专科医生建议的执行情况。慢性肾衰竭患者的乙肝疫苗接种情况是随访指标。会诊后，肾病科医生在给初级保健医生的报告中写明建议接种疫苗。在下一次肾病会诊时，询问患者初级保健医生是否已建议接种疫苗。记录患者的临床、生物学特征及病史，以及初级保健医生会诊的次数和地点。五个肾病中心招募了315名患者。在61.6%（194/315）的病例中，初级保健医生未建议接种疫苗。单因素分析中，仅估算的肾小球滤过率（接种疫苗患者较低，29.5对34.5mL/min/1.73m²）、肾病科医生两次会诊之间的间隔时间（接种疫苗患者较短，18.7对22.9周）以及肾病科医生的执业中心（疫苗接种率为17.5%至52%）具有统计学意义。多因素分析中，仅中心效应仍然显著。2例（1%）中初级保健医生通过信件说明了未接种疫苗的原因。在未直接询问初级保健医生的情况下，不遵循建议的原因仍无法解释。总体而言，肾病科医生的建议很少得到遵循。我们的研究有助于对慢性病患者的联合随访进行思考。
