Effects of physician's specialty on regular chronic kidney disease care in predialysis

Ming Yen Lin, Charles Tzu Chi Lee, Mei Chuan Kuo, Shang Jyh Hwang, Hung Chun Chen, Yi Wen Chiu*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Late referral in chronic kidney disease (CKD) is associated with irregular care and poor prognosis. How the specialty of healthcare provider affect late referral and irregular CKD care remain unclear. We conducted a population-based cross-sectional study to include incident dialysis patients from 2002 to 2007 in Taiwan and observed for 1, 2, and 3 years before dialysis. The medical visits-related information was evaluated every 3 months, retrospectively. Irregular follow-up was defined as missing a follow-up during more than one interval every year. A total of 46,626 patients were included. At 1, 2, and 3 years prior to maintenance dialysis, 87%, 66%, and 50% of patients had regular medical visits; however, only 49%, 23%, and 12% had estimated glomerular filtration rate (EGFR) regularly monitored, respectively. Independent factors of less regular EGFR follow-up included age (adjusted odds ratio (OR) 0.995, 95% confidence interval 0.993-0.998), cardiac disorder (0.90, 0.82-0.99), and stroke (0.76, 0.69-0.84), as well as regular visits at some other specialties (adjusted OR range: from 0.77 to 0.88); whereas, independent factors of less regular visits at nephrology included diabetes mellitus (0.48, 0.46-0.51), cardiac disorder (0.61, 0.56-0.66), stroke (0.53, 0.48-0.58), and regular visits at any other specialty (adjusted OR range: from 0.22 to 0.78). Regular medical visits were quite common in late CKD patients, but they received regular EGFR measurement and visit at nephrology much less frequently. Physicians play a major role in the late referrals in CKD and its irregular care.

Original languageEnglish
Article numbere11317
JournalMedicine (United States)
Volume97
Issue number26
DOIs
Publication statusPublished - 2018 Jun 1

Keywords

  • chronic kidney disease
  • co-care with nephrology
  • healthcare behavior
  • physician's practice patterns
  • quality of predialysis care

ASJC Scopus subject areas

  • Medicine(all)

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