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Table 3 Provision and receipt of primary care services to chronic dialysis patients, by categorya and perspective

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

Perspective Author, Year Summary Findings
Time Delivering Primary Care
 Nephrologist (self-report) Wells, 1986 [16] • 8% spent >75% time on general internal medicine
Bender & Holley, 1996 [14] • 38% mean practice time on primary care issues
Zimmerman, 2003 [17] • 54% devoted >31% time to primary care
Green, 2012 [15] • 85% spend moderate - a lot time managing symptoms (general)
Have/Use/Reliance on Physician for Primary Care
 Nephrologist (self-report) Wells, 1986 [16] • 39% serve as PCP for ≥75% patients
Bender & Holley, 1996 [14] • 20% of patients have a PCP
 PCP (self-report) Zimmerman, 2003 [17] Dialysis patients in PC practice:
• 66% with no dialysis patients
• 29% with 1–2 dialysis patients
• 5% with 3–5 dialysis patients
 Patient (self-report) Nespor & Holley, 1992 [20] • 20% have family doctor
• 80% reliance on nephrologist for annual physical
• 91% reliance on nephrologist for minor illness
Holley & Nespor, 1993 [19] • 29% of patients have family doctor
• 59% of patients visited family practitioner in last 6 months
• 81% reliance on nephrologist for annual physical, minor illness
Zimmerman, 2003 [17] • 87% have a family doctor, of which 65% visited family practitioner ≥2 times per year
Shah, 2005 [23] • General: 35% have PCP
• 1-year before dialysis: 68% have PCP
1-year after dialysis: 29% have PCP
Provision/Receipt of Primary Care Services: Patient Referralsb
 Nephrologist (self-report) Bender & Holley, 1996 [14] • Breast cancer screen - Mammography: 69%
• Cervical cancer screen: 70%
• Colon cancer screen: 43%
• Endocrinologist: 25%
• Cardiologist:76%
• Gastroenterologist: 74%
Zimmerman, 2003 [17] • Breast cancer screen - Mammography: 30%
• Cervical cancer screen: 28%
 PCP (self-report) Zimmerman, 2003 [17] • Breast cancer screen - Mammography: 73%
• Cervical cancer screen: 67%
 Patient (self-report) Nespor & Holley, 1992 [20] By nephrologist:
• Breast cancer screen - Mammography: 49%
• Cardiologist:4%
• Dermatologist: 9%
• Gastroenterologist: 9%
• Surgery (various): 36%
Holley & Nespor, 1993 [19] By nephrologist:
• Breast cancer screen - Mammography: 40%
• Cardiologist:36%
• Endocrinologist: 27%
• Gastroenterologist: 14%
Provision/Receipt of Primary Care Services: Counseling and Preventionb
 Nephrologist (self-report) Bender & Holley, 1996 [14] • Counseling: 79%
• Breast exam: 52%
• Colon cancer screen - Stool hemoccult: 73%
• Offer immunization: 65%
Zimmerman, 2003 [17] • Counseling: 53%
• Breast exam: 10%
• Cervical cancer screen: 28%
• Colon cancer screen - Stool haemoccult: 15%
• Immunization: 74%
 PCP (self-report) Zimmerman, 2003 [17] • Counseling: 77%
• Breast exam: 78%
• Cervical cancer screen: 67%
• Stool haemoccult: 24%
• Immunization: 88%
 Patient (self-report) Nespor & Holley, 1992 [20] By nephrologist:
Annual physical: 80%
By non-nephrologist:
• Eye exam: 58%
• Gynecologic: 56%
• Breast cancer screen - Mammography: 23%
Holley & Nespor, 1993 [19] By non-nephrologist:
• Diabetic eye exam: 72%
• Cervical cancer screen: 72%
• Breast cancer screen - Mammography: 27%
Zimmerman, 2003 [17] Overall:
• Breast cancer screen - Mammography:55%
• Cervical cancer screen: 49%
By nephrologist:
• Annual physical: 21%
By PCP:
• Annual physical: 50%
 Patient (claims, admin) Rodgers, 2000 [27] • Influenza vaccination
 from dialysis facility: 78%
 from neph office: 4%
 from non-neph office: 12%
 from other: 6%
McGrath, 2012 [22] • Influenza vaccination: 48%
Winkelmayer, 2002 [24] • Hemoglobin A1c testing: 11%
• Diabetic eye exam: 76%
• Breast cancer screen: 26%
• Cervical cancer screen: 21%
• Prostate cancer screen: 27%
Gilbertson, 2003 [21] • Influenza vaccination: 48%
Duval, 2011 [26] • Influenza vaccination: 77%
• Pneumonia vaccination: 55%
Provision/Receipt of Primary Care Services: Acute Care, Disease and Symptom Management
 Nephrologist (self-report) Bender & Holley, 1996 [14] • General primary care: 90%
• Treat acute minor illness: 85%
• Disease management
    Hypercholesterolemia: 70%
    Diabetes: 90%
    Cardiac disease:75%
    Gastrointestinal Disease: 69%
Zimmerman, 2003 [17] • Treat minor illness: 72%
• Prescribe meds – lipids: 82%
 – diabetes: 71%
 – heart: 74%
 – gastrointestinal: 59%
Green, 2012 [15] • Treating, “most” of the time
    Pain: 30%
    Depression: 19%
    Sexual dysfunction: 11%
 PCP (self-report) Zimmerman, 2003 [17] • Treat minor illness: 91%
• Prescribe meds – lipids: 78%
 – diabetes: 81%
 – heart: 82%
 – gastrointestinal: 85%
 Patient (self-report) Nespor & Holley, 1992 [20] By nephrologist:
• Minor illness: 91%
• Diabetes: 63%
• Heart disease:53%
• Gastrointestinal disease: 88%
Holley & Nespor, 1993 [19] By nephrologist:
• Diabetes: 73%
• Heart disease:64%
• Gastrointestinal disease: 86%
Zimmerman, 2003 [17] By PCP:
• New problem (by PCP): 83%
• Follow-up of ongoing problem (by PCP): 24%
• Prescribed meds (by PCP): 51%
Claxton, 2010 [18] By nephrologist:
• Physical symptoms: 13–70%
• Mental health symptoms: 0%
By PCP:
• Physical symptoms: 20–63%
• Mental health symptoms: 50–100%
  1. Abbreviation: PCP non-nephrologist primary care provider
  2. Notes:
  3. aReported findings may not be mutually exclusive and appear in multiple outcome categories
  4. bFor certain types of preventive care (e.g., cancer screening), physician referrals and direct delivery of preventive service are differentiated, appearing in separate outcome categories, where indicated