Frequency of patient-physician contact in chronic kidney disease care and achievement of clinical performance targets

摘要

Objective. To examine whether the frequency of physician contact is associated with accepted quality of care measures reflecting clinical performance in chronic kidney disease patients. Design. Prospective cohort study of end-stage renal disease patients begun in 1995, followed for 2.5 years. Setting. 76 not-for-profit US dialysis clinics. Study participants. 678 incident hemodialysis patients for whom we had information on average frequency of patient-physician contact at each clinic (low, monthly or less frequent; intermediate, between monthly and weekly; high, more than weekly), determined by clinic survey. Main outcome measures. Achievement of accepted 6 month clinical performance targets of albumin p-3.5 g/dl), calcium-phosphate (Ca-P) product (＜60 mg~2/dl~2), dialysis dose (Kt/V≥1.2), vascular access type (fistula), and hemoglobin (≥11 g/dl). Results. By logistic regression, patients treated at clinics reporting less frequent physician contact had lower odds of achieving most targets, statistically significantly for albumin [low, adjusted odds ratio (OR)=0.83, 95% confidence interval (CI), 0.55-1.25; intermediate, adjusted OR=0.62, 95% CI, 0.42-0.93; reference, high] and dialysis dose (low, adjusted OR=0.26, 95% CI, 0.08-0.89; intermediate, adjusted OR=0.67, 95% CI, 0.20-2.27); however, they had greater odds of achieving the hemoglobin target (low, adjusted OR=1.94, 95% CI, 1.24-3.04; intermediate, adjusted OR=1.89, 95% CI, 1.27-2.83). Additionally, the number of targets reached was statistically significantly lower in the monthly or less group (adjusted OR=0.43, 95% CI, 0.20-0.94). Conclusions. More frequent patient-physician contact is positively associated with the achievement of clinical performance targets in chronic kidney disease care.