初级保健连续性与家庭透析、移植和开始血液透析患者医疗服务利用的关系

IF 3.4 Q1 UROLOGY & NEPHROLOGY

Kidney Medicine Pub Date : 2025-04-19 DOI:10.1016/j.xkme.2025.101015

Cole S. Wyman , Maya Djerboua , Kristin K. Clemens , Ziv Harel , Manish M. Sood , Samuel A. Silver

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引用次数: 0

摘要

基本原理及目的初级保健可以帮助透析患者获得情感支持和卫生保健服务。目前尚不清楚是否持续访问同一初级保健医生（PCP）可以增强患者选择家庭透析的信心，有助于促进移植的医疗预约，或增加护理机会。研究设计：基于人群的回顾性队列研究。设置,参与者：2007年至2017年在加拿大安大略省开始维持性血液透析的患者。使用常规护理提供者指数（一种已建立的PCP连续性测量方法）的高PCP连续性，定义为在透析开始前2年内使用相同PCP的PCP就诊率为75%。主要结局是家庭透析（腹膜或血液透析）和移植的时间。次要结果包括专科就诊、癌症筛查、流感疫苗接种和糖尿病护理措施。分析方法倾向评分匹配高和低PCP连续性的患者。结果共鉴定出9530对配对。高PCP连续性与家庭透析增加无关(14.0事件/ 100人年vs 14.0事件/ 100人年；子分布风险比1.00；95% CI, 0.97-1.04)或移植(4.3事件/ 100人年vs 4.5事件/ 100人年；亚分布风险比0.97；95% ci, 0.90-1.04)。高PCP连续性与更高的结肠癌筛查相关(风险比1.07；95% CI, 1.01-1.14)，流感疫苗接种(风险比1.33；95% CI, 1.27-1.39)和糖尿病综合护理(风险比1.23；95% ci, 1.14-1.33)。局限性：可能存在残留混淆。结论：透析开始前高PCP连续性与家庭透析或移植使用率的增加无关，但与结肠癌筛查、流感疫苗接种和全面糖尿病护理的增加有关。需要进一步的工作来阐明初级保健如何才能最大限度地使这一患者群体受益。向维持性血液透析过渡的患者需要全面的卫生保健。我们调查了与初级保健医生（PCP）更密切的关系如何补充肾病学家在照顾这一患者群体中的作用。我们使用加拿大安大略省的行政数据库进行了一项基于人群的回顾性研究，评估一种PCP的连续性如何影响家庭透析、肾移植和患者获得卫生保健服务的机会。我们发现，透析开始前的高PCP连续性与家庭透析或肾移植的增加无关，但确实导致结肠癌筛查、流感疫苗接种和糖尿病评估的增加。需要进一步的工作来确定pcp如何帮助肾病学家最好地服务于向维持性血液透析过渡的患者的多方面需求。

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Association of Primary Care Continuity With Home Dialysis, Transplantation, and Utilization of Medical Services for Patients Starting Hemodialysis

Rationale & Objective

Primary care may help patients starting dialysis with emotional support and access to health care services. It is unknown whether consistently visiting the same primary care physician (PCP) can strengthen patient confidence to select home dialysis, help facilitate medical appointments for transplantation, or increase care access.

Study Design

A population-based retrospective cohort study.

Setting & Participants

Patients initiating maintenance hemodialysis from 2007 to 2017 in Ontario, Canada.

Exposure

High PCP continuity using the usual provider of care index (an established measure of PCP continuity), defined as >75% of PCP visits with the same PCP in the 2 years before dialysis initiation.

Outcomes

Primary outcomes were time to home dialysis (peritoneal or hemodialysis) and transplantation. Secondary outcomes included specialist visits, cancer screening, influenza vaccination, and measures of diabetes care.

Analytical Approach

Propensity scores to match patients with high and low PCP continuity.

Results

We identified 9,530 matched pairs. High PCP continuity was not associated with increased home dialysis (14.0 events per 100 person-years vs 14.0 events per 100 person-years; subdistribution hazard ratio 1.00; 95% CI, 0.97-1.04) or transplantation (4.3 events per 100 person-years vs 4.5 events per 100 person-years; subdistribution hazard ratio 0.97; 95% CI, 0.90-1.04). High PCP continuity was associated with greater colon cancer screening (hazard ratio 1.07; 95% CI, 1.01-1.14), influenza vaccination (hazard ratio 1.33; 95% CI, 1.27-1.39), and comprehensive diabetes care (hazard ratio 1.23; 95% CI, 1.14-1.33).

Limitations

Residual confounding is possible.

Conclusions

High PCP continuity before dialysis initiation was not associated with increased utilization of home dialysis or transplantation but was associated with greater colon cancer screening, influenza vaccination, and comprehensive diabetes care. Additional work is needed to clarify how primary care may best benefit this patient population.

Plain Language Summary

Patients transitioning to maintenance hemodialysis require comprehensive health care. We investigated how closer relationships with a primary care physician (PCP) may complement nephrologists in caring for this patient population. We used administrative databases in Ontario, Canada, to conduct a retrospective population-based study, assessing how continuity with one PCP influenced the uptake of home dialysis, kidney transplantation, and patient access to health care services. We found that high PCP continuity before dialysis initiation was not associated with increased transition to home dialysis or kidney transplantation but did lead to increases in colon cancer screening, influenza vaccination, and diabetes assessment. Further work is required to determine how PCPs can help nephrologists best serve the multifaceted needs of patients transitioning to maintenance hemodialysis.

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