Quality of Patient-Physician Discussions About CKD in Primary Care: A Cross-sectional Study

• Published in: American journal of kidney diseases Vol. 57; no. 4; pp. 583 - 591
• Main Authors: Greer, Raquel C., MD, MHS, Cooper, Lisa A., MD, MPH, Crews, Deidra C., MD, ScM, Powe, Neil R., MD, MPH, MBA, Boulware, L. Ebony, MD, MPH
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2011; Elsevier
• Subjects: Biological and medical sciences; Chronic Disease; Chronic kidney disease; Communication; Cross-Sectional Studies; Educational Status; Female; Humans; Hypertension - complications; Kidney Diseases - epidemiology; Kidneys; Male; Medical sciences; Middle Aged; Nephrology; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Outcome Assessment, Health Care; patient awareness; patient-physician communication; Physician-Patient Relations; Physicians, Primary Care; primary care; Randomized Controlled Trials as Topic; Renal failure; Risk Factors; Urinary system involvement in other diseases. Miscellaneous; primary care; patient-physician communication; Chronic kidney disease; patient awareness; Kidney disease; Human; Nephrology; Urinary system disease; Primary health care; Awareness; Physician; Urology; Physician patient relation; Cross sectional study; Quality; Renal failure; Discussion
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2010.08.027

Background The quality of patient-physician discussions about chronic kidney disease (CKD) in primary care has not been studied previously. Study Design Cross-sectional study. Settings & Participants We audiotaped encounters between 236 patients with hypertension and their primary care physicians (n = 40). Predictors Patient, physician, and encounter characteristics. Outcomes & Measurements We described the occurrence and characteristics (content, use of technical terms, and physician assessment of patient comprehension of new concepts) of CKD discussions. We assessed patient and physician characteristics associated with CKD discussion occurrence. Results Many patients (mean age, 59 years) had uncontrolled hypertension (51%), diabetes (44%), and/or 3 or more comorbid conditions (51%). Most primary care physicians practiced (52%) fewer than 10 years. CKD discussions occurred in few (26%; n = 61) encounters, with content focused on laboratory assessment (89%), risk-factor treatment (28%), and causes (26%) of CKD. In encounters that included a CKD discussion, physicians used technical terms (28%; n = 17) and rarely assessed patients' comprehension (2%; n = 1). CKD discussions were statistically significantly less common in visits of patients with some (vs no) college education (OR, 0.23; 95% CI, 0.09-0.56), with 3 or more (vs fewer) comorbid conditions (OR, 0.49; 95% CI, 0.25-0.96), and who saw physicians with more (vs fewer) than 10 years of practice experience (OR, 0.41; 95% CI, 0.21-0.80). CKD discussions were more common during longer encounters (OR, 1.31; 95% CI, 1.04-1.65) and encounters in which diabetes was (vs was not) discussed (OR, 2.87; 95% CI, 1.22-6.77). Limitations Generalizability of our findings may be limited. Conclusions Patient-physician discussions about CKD in high-risk primary care patients were infrequent. Physicians used technical terms and infrequently assessed patients' understanding of new CKD concepts. Efforts to improve the frequency and content of patient-physician CKD discussions in primary care could improve patients' clinical outcomes.