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Int J Qual Health Care. 2005 Apr;17(2):115-21. Epub 2005 Feb 21.

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

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  • 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, 2024 E. Monument Street, Baltimore, MD 21205, USA.

Abstract

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 (> or =3.5 g/dl), calcium-phosphate (Ca-P) product (<60 mg(2)/dl(2)), dialysis dose (Kt/V > or = 1.2), vascular access type (fistula), and hemoglobin (> or =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.

PMID:
15723821
[PubMed - indexed for MEDLINE]
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