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