Dataset Information

Impact of superimposed nephrological care to guidelines-directed management by primary care physicians of patients with stable chronic kidney disease: a randomized controlled trial.

ABSTRACT: BACKGROUND:Optimal clinical care of patients with chronic kidney disease (CKD) requires collaboration between primary care physicians (PCPs) and nephrologists. We undertook a randomised trial to determine the impact of superimposed nephrologist care compared to guidelines-directed management by PCPs in CKD patients after hospital discharge. METHODS:Stage 3b-4 CKD patients were enrolled during a hospitalization and randomised in two arms: Co-management by PCPs and nephrologists (interventional arm) versus management by PCPs with written instructions and consultations by nephrologists on demand (standard care). Our primary outcome was death or rehospitalisation within the 2?years post-randomisation. Secondary outcomes were: urgent renal replacement therapy (RRT), decline of renal function and decrease of quality of life at 2?years. RESULTS:From November 2009 to the end of June 2013, we randomised 242 patients. Mean follow-up was 51 + 20?months. Survival without rehospitalisation, GFR decline and elective dialysis initiation did not differ between the two arms. Quality of life was also similar in both groups. Compared to randomised patients, those who either declined to participate in the study or were previously known by nephrologists had a worse survival. CONCLUSION:These results do not demonstrate a benefit of a regular renal care compared to guided PCPs care in terms of survival or dialysis initiation in CKD patients. Increased awareness of renal disease management among PCPs may be as effective as a co-management by PCPs and nephrologists in order to improve the prognosis of moderate-to-severe CKD. TRIAL REGISTRATION:This study was registered on June 29, 2009 in clinicaltrials.gov (NCT00929760) and adheres to CONSORT 2010 guidelines.

SUBMITTER: Saudan P

PROVIDER: S-EPMC7147051 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Impact of superimposed nephrological care to guidelines-directed management by primary care physicians of patients with stable chronic kidney disease: a randomized controlled trial.

Saudan Patrick P Ponte Belen B Marangon Nicola N Martinez Chantal C Berchtold Lena L Jaques David D Ernandez Thomas T de Seigneux Sophie S Carballo Sebastian S Perneger Thomas T Martin Pierre-Yves PY

BMC nephrology 20200409 1

<h4>Background</h4>Optimal clinical care of patients with chronic kidney disease (CKD) requires collaboration between primary care physicians (PCPs) and nephrologists. We undertook a randomised trial to determine the impact of superimposed nephrologist care compared to guidelines-directed management by PCPs in CKD patients after hospital discharge.<h4>Methods</h4>Stage 3b-4 CKD patients were enrolled during a hospitalization and randomised in two arms: Co-management by PCPs and nephrologists (in ...[more]

PMID: 32272886

Similar Datasets

Project description:Background and objectives: Although primary care clinicians provide >60% of U.S. asthma care, no nationally representative study has examined variation in adherence among primary care groups to four cornerstone domains of the Expert Panel Report-3 asthma guidelines: assessment/monitoring, patient education, environmental assessment, and medications. We used the 2012 National Asthma Survey of Physicians: National Ambulatory Medical Care Survey to compare adherence by family/general medicine practitioners (FM/GM), internists, pediatricians and Community Health Center mid-level clinicians (CHC). Methods: Adherence was self-reported (n = 1355 clinicians). Adjusted odds of almost always adhering to each recommendation (≥75% of the time) were estimated controlling for clinician/practice characteristics, and agreement and self-efficacy with guideline recommendations. Results: A higher percentage of pediatricians adhered to most assessment/monitoring recommendations compared to FM/GM and other groups (e.g. 71.6% [SE 4.0] almost always assessed daytime symptoms versus 50.6% [SE 5.1]-51.1% [SE 5.8], t-test p < 0.05) but low percentages from all groups almost always performed spirometry (6.8% [SE 2.0]-16.8% [SE 4.7]). Pediatricians were more likely to provide asthma action/treatment plans than FM/GM and internists. Internists were more likely to assess school/work triggers than pediatricians and CHC (environmental assessment). All groups prescribed inhaled corticosteroids for daily control (84.0% [SE 3.7]-90.7% [SE 2.5]) (medications). In adjusted analyses, pediatric specialty, high self-efficacy and frequent specialist referral were associated with high adherence. Conclusions: Pediatricians were more likely to report high adherence than other clinicians. Self- efficacy and frequent referral were also associated with adherence. Adherence was higher for history-taking recommendations and lower for recommendations involving patient education, equipment and expertise.

Project description:BACKGROUND:Multiple clinical practice guidelines exist for breast and cervical cancer screening, and differ in aggressiveness with respect to the recommended frequency and target populations for screening. OBJECTIVES:To determine (1) US primary care physicians' (PCPs) perceptions of the influence of different clinical practice guidelines; (2) the relationship between the number, aggressiveness, and agreement of influential guidelines and the aggressiveness of physicians' screening recommendations; and (3) factors associated with guideline perceptions. RESEARCH DESIGN AND METHODS:A nationally representative sample of 1212 PCPs was surveyed in 2006-2007. Cross-sectional analyses examined physicians' perceptions of the influence of different breast and cervical cancer screening guidelines, the relationship of guideline perceptions to screening recommendations in response to hypothetical vignettes, and the predictors of guideline perceptions. RESULTS:American Cancer Society and American College of Obstetricians and Gynecologists guidelines were perceived as more influential than other guidelines. Most physicians (62%) valued multiple guidelines, and conflicting and aggressive rather than conservative guideline combinations. The number, aggressiveness, and agreement of influential guidelines were associated with the aggressiveness of screening recommendations (P < 0.01)-which was highest for physicians valuing multiple-aggressive, lowest for physicians valuing multiple-conservative, and intermediate for physicians valuing multiple-conflicting, single, and no guidelines. Obstetrician/gynecologists specialty predicted valuation of aggressive guidelines (P < 0.001). CONCLUSIONS:PCPs' perceptions of cancer screening guidelines vary, relate to screening recommendations in logically-consistent ways, and are predicted by specialty and other factors. The number, aggressiveness, and agreement of valued guidelines are associated with screening recommendations, suggesting that guideline multiplicity is an important problem in clinical decision-making.

Dataset Information

Impact of superimposed nephrological care to guidelines-directed management by primary care physicians of patients with stable chronic kidney disease: a randomized controlled trial.

Publications

Impact of superimposed nephrological care to guidelines-directed management by primary care physicians of patients with stable chronic kidney disease: a randomized controlled trial.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets