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% |
|
Abbreviation: PCP non-nephrologist primary care provider
Notes:
aReported findings may not be mutually exclusive and appear in multiple outcome categories
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