Bartolomeo K, Tandon Gandhir A, Lipinski M, Romeu J, Ghahramani N
Division of Nephrology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA.
Int J Organ Transplant Med. 2019;10(3):101-107.
Provider perceptions about patient candidacy for kidney transplant (KT) are potentially significant contributors to disparities in KT.
To examine nephrologists' perceptions about factors that are important in excluding patients from KT referral, and to analyze the association between these perceptions and nephrologists' demographic and practice characteristics.Methods: Invitations were sent to 3180 nephrologists. Among those who consented, 822 fulfilled the inclusion criteria, and 250 were randomly invited to complete a questionnaire about perceptions of factors essential in deciding not to refer patients for KT.
Responses from 216 participants with complete responses were analyzed. The 3 most common reasons for excluding patients were "patient's inadequate social support" (44%), "limited understanding of the process due to patient's inadequate education" (32%), and "patient's age above 65" (26%). Nephrologists practicing in rural settings were more likely to consider inadequate support and limited education of patients as reasons not to refer for KT. In multivariate analysis, physicians with 2 or fewer transplant centers within 50 miles were more likely to report inadequate social support (OR: 3.15, 95% CI: 1.59-6.24) and age greater than 65 years (OR: 1.88, 95% CI: 1.01-3.49) as reasons to exclude patients from KT referral. Nephrologists whose practice included patients majority of whom had not completed high school were more likely to consider limited understanding due to inadequate education as an important reason to exclude patients from KT (OR: 3.31, 95% CI: 1.60-6.86).
Patient's social support, understanding, and age were the most common factors regarded by nephrologists as important in not referring patients for KT evaluation. Practice location, particularly rural setting, proximity to a transplant center, and the education level of a nephrologist's patient population were important determinants of referral for KT.
医疗服务提供者对肾移植（KT）患者候选资格的看法可能是导致KT差异的重要因素。
研究肾病学家对将患者排除在KT转诊之外的重要因素的看法，并分析这些看法与肾病学家的人口统计学和执业特征之间的关联。
向3180名肾病学家发出邀请。在同意参与的人中，822人符合纳入标准，随机邀请250人填写一份关于决定不将患者转诊至KT的重要因素看法的问卷。
分析了216名给出完整回复参与者的回答。排除患者的3个最常见原因是“患者社会支持不足”（44%）、“由于患者教育程度不足对流程理解有限”（32%）和“患者年龄超过65岁”（26%）。在农村地区执业的肾病学家更有可能将患者支持不足和教育程度有限视为不转诊至KT的原因。在多变量分析中，在50英里范围内有2个或更少移植中心的医生更有可能将社会支持不足（比值比：3.15，95%置信区间：1.59 - 6.24）和年龄大于65岁（比值比：1.88，95%置信区间：1.01 - 3.49）作为将患者排除在KT转诊之外的原因。其执业患者多数未完成高中学业的肾病学家更有可能将由于教育不足导致的理解有限视为将患者排除在KT之外的重要原因（比值比：3.31，95%置信区间：1.60 - 6.86）。
患者的社会支持、理解能力和年龄是肾病学家认为不将患者转诊至KT评估的最重要常见因素。执业地点，特别是农村地区、与移植中心的距离以及肾病学家患者群体的教育水平是KT转诊的重要决定因素。
