Minding the gap and overlap: a literature review of fragmentation of primary care for chronic dialysis patients

BMC Nephrology

Research Article

JaNell Wylie¹  Virginia Wang²  Clarissa J. Diamantidis³  Raquel C. Greer⁴ 

[1] Department of Orthopaedics, Duke University School of Medicine, Durham, NC, USA;Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 27710, Durham, NC, USA;Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA;Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA;Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 27710, Durham, NC, USA;Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA;Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA;

关键词: Primary care services;    Maintenance dialysis;    Physicians;    Coordination of care;    Outcomes;   

DOI  :  10.1186/s12882-017-0689-0

 received in 2017-05-10, accepted in 2017-08-15,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundCare coordination is a challenge for patients with kidney disease, who often see multiple providers to manage their associated complex chronic conditions. Much of the focus has been on primary care physician (PCP) and nephrologist collaboration in the early stages of chronic kidney disease, but less is known about the co-management of the patients in the end-stage of renal disease. We conducted a systematic review and synthesis of empirical studies on primary care services for dialysis patients.MethodsSystematic literature search of MEDLINE/PubMED, CINAHL, and EmBase databases for studies, published until August 2015. Inclusion criteria included publications in English, empirical studies involving human subjects (e.g., patients, physicians), conducted in US and Canadian study settings that evaluated primary care services in the dialysis patient population.ResultsFourteen articles examined three major themes of primary care services for dialysis patients: perceived roles of providers, estimated time in providing primary care, and the extent of dialysis patients’ use of primary care services. There was general agreement among providers that PCPs should be involved but time, appropriate roles, and miscommunication are potential barriers to good primary care for dialysis patients. Although many dialysis patients report having a PCP, the majority rely on primary care from their nephrologists. Studies using administrative data found lower rates of preventive care services than found in studies relying on provider or patient self-report.DiscussionThe extant literature revealed gaps and opportunities to optimize primary care services for dialysis patients, foreshadowing the challenges and promise of Accountable Care / End-Stage Seamless Care Organizations and care coordination programs currently underway in the United States to improve clinical and logistical complexities of care for this commonly overlooked population. Studies linking the relationship between providers and patients’ receipt of primary care to outcomes will serve as important comparisons to the nascent care models for ESRD patients, whose value is yet to be determined.

【 授权许可】

CC BY   
© The Author(s). 2017