Raffray Maxime, Vigneau Cécile, Couchoud Cécile, Laude Laetitia, Campéon Arnaud, Schweyer François-Xavier, Bayat Sahar
Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, F-35000 Rennes, France.
Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France.
Ther Adv Chronic Dis. 2022 Sep 29;13:20406223221108397. doi: 10.1177/20406223221108397. eCollection 2022.
Effective collaboration between general practitioners (GP) and nephrologists is crucial in CKD care. We aimed to analyse GPs' and nephrologists' presence and involvement in CKD care and assess how they intertwine to shape patients' trajectories.
We conducted a mixed-methods study that included all patients with CKD who started dialysis in France in 2015 (the REIN registry) and a sample of nephrologists and GPs. We quantified professionals' presence through patients' reimbursed healthcare from the French National Health Data System, 2 years before and 1 year after dialysis start. Involvement in CKD care was derived from the nephrologists' and GPs' interviews.
Among 8856 patients included, nephrologists' presence progressively increased from 29% to 67% of patients with a contact during the 2 years before dialysis start. However, this was partly dependent on the GPs' referral practices. Interviews revealed that GPs initially controlled the therapeutic strategy on their own. Although unease grew with CKD's management complexity, reducing their involvement in favour of nephrologists, GPs' presence remained frequent throughout the pre-dialysis period. Upon dialysis start, nephrologists' presence and involvement became total, while GPs' greatly decreased (48% of patients with a contact at month 12 after dialysis start). Collaboration was smooth when GPs maintained contact with patients and could contribute to their care through aspects of their specialty they valued.
This mixed-methods study shows presences and forms of involvement of GPs and nephrologists in CKD care adjusting along the course of CKD and unveils the mechanisms at play in their collaboration.
全科医生（GP）与肾病科医生之间的有效合作对慢性肾脏病（CKD）护理至关重要。我们旨在分析全科医生和肾病科医生在CKD护理中的参与情况，并评估他们如何相互交织以塑造患者的病程。
我们开展了一项混合方法研究，纳入了2015年在法国开始透析的所有CKD患者（REIN登记册）以及肾病科医生和全科医生的样本。我们通过法国国家卫生数据系统中患者透析开始前2年和开始后1年的医保报销医疗服务来量化专业人员的参与情况。对CKD护理的参与情况来自肾病科医生和全科医生的访谈。
在纳入的8856名患者中，肾病科医生的参与度在透析开始前2年从29%逐步增加到有接触患者的67%。然而，这部分取决于全科医生的转诊做法。访谈显示，全科医生最初独自控制治疗策略。尽管随着CKD管理复杂性的增加，他们的不安情绪加剧，减少了自己的参与而倾向于肾病科医生，但在透析前期，全科医生的参与仍然频繁。透析开始后，肾病科医生的参与度变为全面参与，而全科医生的参与度大幅下降（透析开始后12个月有接触患者的比例为48%）。当全科医生与患者保持联系并能通过他们重视的专业领域为患者护理做出贡献时，合作就很顺利。
这项混合方法研究显示了全科医生和肾病科医生在CKD护理中的参与情况和形式，以及它们如何随着CKD病程而调整，并揭示了他们合作中起作用的机制。
