Kidney Week

Abstract: TH-PO289

The Primary Cares Survey of In-Unit Dialysis Patient Primary Care Choices

Session Information

• Dialysis: Cost, Socioeconomics, Quality of Life
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Perlman, Alan, Rogosin Institute, New York, New York, United States

Alan Perlman,

• Epstein, David L., Rogosin Institute, New York, New York, United States

David L. Epstein,

• Parker, Thomas, Rogosin Institute, New York, New York, United States

Thomas Parker,

• Levine, Daniel, Rogosin Institute, New York, New York, United States

Daniel Levine,

• Lin, Jonathan T., Rogosin Institute, New York, New York, United States

Jonathan T. Lin,

• Guo, Xunxi Susan, NYP-Weill Cornell, New York, New York, United States

Xunxi Susan Guo,

• Farrukh, Omar, NYP-Weill Cornell, New York, New York, United States

Omar Farrukh,

• Gutgarts, Victoria, NYP-Weill Cornell, New York, New York, United States

Victoria Gutgarts,

• Phillips, Molly R., Rogosin Institute, New York, New York, United States

Molly R. Phillips,

• Srisung, Weeraporn, NYP-Weill Cornell, New York, New York, United States

Weeraporn Srisung,

• Lamba, Perola, NYP-Weill Cornell, New York, New York, United States

Perola Lamba,

• Baskharoun, Samuel, Frank H. Netter MD School of Medicine, New Haven, Connecticut, United States

Samuel Baskharoun,

• Liu, Frank, Rogosin Institute, New York, New York, United States

Frank Liu,

Background

The complexity of primary care(PC) management of patients undergoing chronic dialysis often leads to confusion by the patient, nephrologist and traditional PC practitioners regarding the responsibility for the management of their care. In addition to renal failure, dialysis patients have a significant number of co-morbid medical conditions and require numerous medications. Common beliefs regarding PC by patients and their practitioners are not well characterized. Centers for Medicare and Medicaid Services(CMS) has advanced the notion of the patient centered model of care. With the implementation of the ESRD Seamless Care Organizations(ESCO), CMS has placed the dialysis facility and providers as the principal coordinators of patient care, thus implying that PC provisions are incorporated. Ultimately, patients preferences are integral to care delivery and may prove intrinsic to the success or failure of the ESCO model. The objective of the survey is to characterize attitudes amongst dialysis patients regarding PC provisions.

Methods

The PRIMARY CARES (Primary Care Attitudes and Renal Replacement Selection) survey was performed in 7 HD units in the NYC area representing a diverse population of ethnicities, languages (5) and socioeconomic categories with the objective of assessing factors influencing the utilization of PC services.

Results

832 patients were approached and 511 completed the survey. Of these, 396 (77%) completed the question regarding having someone whom they consider to be their PC provider(PCP) with 44% reporting their PCP was their internist(IM) or family practitioner(FP) vs 45% reporting their nephrologist as their PCP. Regarding which practitioner they would seek for first management of an acute issue, 48% stated their IM/FP vs 38% their nephrologist. Regarding patient preference for PCP, 41% reported their IM/FP vs 44% for nephrologist.

Conclusion

Our results indicate that a significant percentage of dialysis patients identify, utilize and prefer non-nephrology practitioners rather than their nephrologists for acute medical care and PC needs. In the ESCO model, patient preference for, and utilization of, services outside the purview of the dialysis center is likely to have important consequences on the overall success of the program.