医生和高级执业医师对慢性肾脏病的识别。
Chronic kidney disease recognition amongst physicians and advanced practice providers.
机构信息
Nephrology, Critical Care Medicine Department, WellStar Health System, Marietta, GA, USA.
Internal Medicine, WellStar Health System, Marietta, GA, USA.
出版信息
Ren Fail. 2021 Dec;43(1):1276-1280. doi: 10.1080/0886022X.2021.1974474.
OBJECTIVE
Chronic kidney disease is a worldwide public health issue, with increasing prevalence resulting in high morbidity and mortality. As a result, recognizing and treating it early can lead to improved outcomes. We hypothesized that some providers might be more comfortable making this diagnosis than others.
METHODS
Retrospective study of 380 patients with chronic kidney disease seen between 2012 and 2016 in an outpatient setting.
RESULTS
Three hundred and sixteen patients were treated by physicians and sixty-four by advanced practice providers. Chronic kidney disease was identified by the primary care providers in 318 patients (83.6%). Patients recognized with chronic kidney disease were older, 76 ± 8.8 vs 72 ± 7.45 years, = 0.001; had lower GFR, 37 [29, 46] vs 57 [37, 76] ml/min/1.73 m, < 0.0001 and were more likely to be seen by a physician compared to an advanced practice provider: 272/316 (86%) vs 46/64 (71.8%), = 0.008. In multivariate analyses, care by a physician, OR = 2.27 (1.13-4.58), = 0.02 was associated with increased recognition of chronic kidney disease. On the other hand, higher GFR was associated with decreased diagnosis of chronic kidney disease, OR = 0.95 (0.93-0.96), < 0.0001.
CONCLUSION
The odds of chronic kidney disease recognition were higher amongst physicians in comparison to non-physician providers.
目的
慢性肾脏病是一个全球性的公共卫生问题，其患病率不断上升，导致发病率和死亡率居高不下。因此，早期发现和治疗可以改善预后。我们假设，一些医生可能比其他医生更擅长做出这一诊断。
方法
对 2012 年至 2016 年间在门诊就诊的 380 例慢性肾脏病患者进行回顾性研究。
结果
316 例患者由医生治疗，64 例患者由高级实践提供者治疗。初级保健提供者在 318 例患者（83.6%）中确定了慢性肾脏病。被诊断为慢性肾脏病的患者年龄较大，76±8.8 岁比 72±7.45 岁， = 0.001；肾小球滤过率（GFR）较低，37[29,46]ml/min/1.73m 比 57[37,76]ml/min/1.73m， < 0.0001，并且更有可能由医生而不是高级实践提供者治疗：272/316（86%）比 46/64（71.8%）， = 0.008。在多变量分析中，医生治疗，OR=2.27（1.13-4.58）， = 0.02，与慢性肾脏病的识别增加相关。另一方面，较高的 GFR 与慢性肾脏病诊断的减少相关，OR=0.95（0.93-0.96）， < 0.0001。
结论
与非医师提供者相比，医生识别慢性肾脏病的几率更高。
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