Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
BMC Nephrol. 2021 May 5;22(1):164. doi: 10.1186/s12882-021-02368-0.
Demands of dialysis regimens may pose challenges for primary care provider (PCP) engagement and timely preventive care. This is especially the case for patients initiating dialysis adjusting to new logistical challenges and management of symptoms and existing comorbid conditions. Since 2011, Medicare has provided coverage for annual wellness visits (AWV), which are primarily conducted by PCPs and may be useful for older adults undergoing dialysis.
We used the OptumLabs® Data Warehouse to identify a cohort of 1,794 Medicare Advantage (MA) enrollees initiating dialysis in 2014-2017 and examined whether MA enrollees (1) were seen by a PCP during an outpatient visit and (2) received an AWV in the year following dialysis initiation.
In the year after initiating dialysis, 93 % of MA enrollees had an outpatient PCP visit but only 24 % received an annual wellness visit. MA enrollees were less likely to see a PCP if they had Charlson comorbidity scores between 0 and 5 than those with scores 6-9 (odds ratio (OR) = 0.59, 95 % CI: 0.37-0.95), but more likely if seen by a nephrologist (OR = 1.60, 95 % CI: 1.01-2.52) or a PCP (OR = 15.65, 95 % CI: 9.26-26.46) prior to initiation. Following dialysis initiation, 24 % of MA enrollees had an AWV. Hispanic MA enrollees were less likely (OR = 0.57, 95 % CI: 0.39-0.84) to have an AWV than White MA enrollees, but enrollees were more likely if they initiated peritoneal dialysis (OR = 1.54, 95 % CI: 1.07-2.23) or had an AWV in the year before dialysis initiation (OR = 4.96, 95 % CI: 3.88-6.34).
AWVs are provided at low rates to MA enrollees initiating dialysis, particularly Hispanic enrollees, and represent a missed opportunity for better care management for patients with ESKD. Increasing patient awareness and provider provision of AWV use among dialysis patients may be needed, to realize better preventive care for dialysis patients.
透析方案的需求可能对初级保健提供者（PCP）的参与和及时的预防保健构成挑战。对于开始透析的患者来说，情况尤其如此，他们需要适应新的后勤挑战，并管理症状和现有合并症。自 2011 年以来，医疗保险已为年度健康访视（AWV）提供了覆盖范围，主要由 PCP 进行，这可能对正在接受透析的老年人有用。
我们使用 OptumLabs®Data Warehouse 确定了一组在 2014-2017 年开始透析的 1794 名医疗保险优势（MA）参保者队列，并检查 MA 参保者是否：（1）在门诊就诊期间接受了 PCP 治疗；（2）在透析开始后的一年中接受了年度健康访视。
在开始透析后的一年中，93%的 MA 参保者进行了门诊 PCP 就诊，但只有 24%接受了年度健康访视。与 Charlson 合并症评分为 6-9 的患者相比，评分为 0-5 的患者不太可能看 PCP（比值比（OR）=0.59，95%CI：0.37-0.95），但如果在此之前由肾病医生（OR=1.60，95%CI：1.01-2.52）或 PCP（OR=15.65，95%CI：9.26-26.46）就诊，则更有可能就诊。透析后，24%的 MA 参保者接受了年度健康访视。西班牙裔 MA 参保者接受年度健康访视的可能性较低（OR=0.57，95%CI：0.39-0.84），但如果开始腹膜透析（OR=1.54，95%CI：1.07-2.23）或在透析前一年接受年度健康访视（OR=4.96，95%CI：3.88-6.34），则可能性更高。
向开始透析的 MA 参保者提供年度健康访视的比例较低，特别是西班牙裔参保者，这是对终末期肾病患者更好的护理管理的错失机会。可能需要提高患者的意识，并增加透析患者中年度健康访视的使用，以实现对透析患者更好的预防保健。
