Bender F H, Holley J L
Renal-Electrolyte Division of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Am J Kidney Dis. 1996 Jul;28(1):67-71. doi: 10.1016/s0272-6386(96)90132-8.
The medical care of end-stage renal disease (ESRD) patients includes not only dialysis-related medical care but preventive and general medical care as well as the care of minor acute illnesses. There is little information about nephrologists' interpretation of their potential role as a primary health care provider for the general medical needs of chronic dialysis patients. To characterize nephrologists' primary care practice patterns related to the care of chronic dialysis patients, we surveyed a randomly selected group of practicing nephrologists and asked questions about preventive medicine guidelines followed, treatment of minor acute illnesses, and management of chronic medical problems in ESRD patients. The results of 233 questionnaires (46% response rate) were analyzed. Most of the responding nephrologists were men (91%), were board certified in internal medicine (96%) and nephrology (83%), were out of nephrology practice for a mean of 16 years, had a mean age of 48 +/- 7 years, and were in private practice (65%). The average percentage of time spent with chronic dialysis patients was reported as 30%; 38% of that time was devoted to the general medical care of those patients. Ninety percent of nephrologists reported that they provided primary care to their dialysis patients, and only 21% said a nurse practitioner or physician assistant worked with them. Age and number of years in practice were the only demographic factors increasing the likelihood of nephrologist-provided primary care, with older, more experienced practitioners more likely to be providing primary care to dialysis patients. Most nephrologists reported that they managed minor acute illnesses and comorbid conditions (diabetes mellitus, cardiac disease, and gastrointestinal disease) in their dialysis patients. Nephrology fellowship training programs and recertification programs may need to address issues of primary general health care of ESRD patients. Plans under development for health care programs and reimbursement criteria also need to recognize and consider the primary medical care role practiced by nephrologists caring for ESRD patients.
终末期肾病（ESRD）患者的医疗护理不仅包括与透析相关的医疗护理，还包括预防和普通医疗护理以及轻微急性疾病的护理。关于肾病专家如何看待自己作为慢性透析患者一般医疗需求的初级保健提供者的潜在作用，目前几乎没有相关信息。为了描述肾病专家在慢性透析患者护理方面的初级保健实践模式，我们对一组随机挑选的执业肾病专家进行了调查，询问了他们遵循的预防医学指南、轻微急性疾病的治疗以及ESRD患者慢性医疗问题的管理等问题。对233份问卷的结果（回复率为46%）进行了分析。大多数回复的肾病专家为男性（91%），具有内科（96%）和肾病学（83%）的委员会认证，平均脱离肾病学实践16年，平均年龄为48±7岁，并且从事私人执业（65%）。据报告，与慢性透析患者相处的平均时间百分比为30%；其中38%的时间用于这些患者的普通医疗护理。90%的肾病专家报告称他们为透析患者提供初级保健，只有21%的人表示有执业护士或医师助理与他们一起工作。年龄和从业年限是仅有的增加肾病专家提供初级保健可能性的人口统计学因素，年龄较大、经验更丰富的从业者更有可能为透析患者提供初级保健。大多数肾病专家报告称他们管理透析患者的轻微急性疾病和合并症（糖尿病、心脏病和胃肠道疾病）。肾病学进修培训项目和重新认证项目可能需要解决ESRD患者初级普通医疗保健的问题。正在制定的医疗保健项目计划和报销标准也需要认识并考虑照顾ESRD患者的肾病专家所发挥的初级医疗护理作用。
