西班牙裔慢性肾脏病患者的初级保健医生就诊体验与住院风险。
Patient Experience with Primary Care Physician and Risk for Hospitalization in Hispanics with CKD.
机构信息
Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
Clin J Am Soc Nephrol. 2018 Nov 7;13(11):1659-1667. doi: 10.2215/CJN.03170318. Epub 2018 Oct 18.
BACKGROUND AND OBJECTIVES
In the general population, the quality of the patient experience with their primary care physician may influence health outcomes but this has not been evaluated in CKD. This is relevant for the growing Hispanic CKD population, which potentially faces challenges to the quality of the patient experience related to language or cultural factors. We evaluated the association between the patient experience with their primary care physician and outcomes in Hispanics with CKD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This prospective observational study included 252 English- and Spanish-speaking Hispanics with entry eGFR of 20-70 ml/min per 1.73 m, enrolled in the Hispanic Chronic Renal Insufficiency Cohort study between 2005 and 2008. Patient experience with their primary care physician was assessed by the Ambulatory Care Experiences Survey subscales: communication quality, whole-person orientation, health promotion, interpersonal treatment, and trust. Poisson and proportional hazards models were used to assess the association between the patient experience and outcomes, which included hospitalization, ESKD, and all-cause death.
RESULTS
Participants had a mean age of 56 years, 38% were women, 80% were primary Spanish speakers, and had a mean eGFR of 38 ml/min per 1.73 m. Over 4.8 years (median) follow-up, there were 619 hospitalizations, 103 ESKD events, and 56 deaths. As compared with higher subscale scores, lower scores on four of the five subscales were associated with a higher adjusted rate ratio (RR) for all-cause hospitalization (communication quality: RR, 1.54; 95% confidence interval [95% CI], 1.25 to 1.90; health promotion: RR, 1.31; 95% CI, 1.05 to 1.62; interpersonal treatment: RR, 1.50; 95% CI, 1.22 to 1.85; and trust: RR, 1.57; 95% CI, 1.27 to 1.93). There was no significant association of subscales with incident ESKD or all-cause death.
CONCLUSIONS
Lower perceived quality of the patient experience with their primary care physician was associated with a higher risk of hospitalization.
背景和目的
在普通人群中，患者与初级保健医生的就诊体验质量可能会影响健康结局，但这一点尚未在 CKD 患者中得到评估。对于不断增长的西班牙裔 CKD 患者群体而言，这一点尤为重要，因为他们可能面临与语言或文化因素相关的就诊体验质量挑战。本研究旨在评估 CKD 西班牙裔患者与初级保健医生的就诊体验与结局之间的相关性。
设计、地点、参与者和测量方法：本前瞻性观察性研究纳入了 252 名入组时估算肾小球滤过率（eGFR）为 20-70 ml/min/1.73m2 的英语和西班牙语母语的西班牙裔患者，他们于 2005 年至 2008 年间参加了 Hispanic Chronic Renal Insufficiency Cohort 研究。采用门诊护理体验调查量表的亚量表评估患者与初级保健医生的就诊体验：沟通质量、全人导向、健康促进、人际治疗和信任。采用泊松和比例风险模型评估就诊体验与结局之间的相关性，结局包括住院治疗、终末期肾病（ESKD）和全因死亡。
结果
参与者的平均年龄为 56 岁，38%为女性，80%为西班牙语母语者，平均 eGFR 为 38 ml/min/1.73m2。中位随访时间为 4.8 年期间，发生了 619 次住院治疗、103 例 ESKD 事件和 56 例死亡。与较高的亚量表评分相比，五个亚量表中的四个亚量表评分较低与全因住院治疗的校正风险比（RR）较高相关（沟通质量：RR，1.54；95%置信区间[95%CI]，1.25 至 1.90；健康促进：RR，1.31；95%CI，1.05 至 1.62；人际治疗：RR，1.50；95%CI，1.22 至 1.85；信任：RR，1.57；95%CI，1.27 至 1.93）。亚量表与新发 ESKD 或全因死亡无显著相关性。
结论
患者对与初级保健医生就诊体验的感知质量较差与住院风险增加相关。
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