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Kidney Week

Abstract: PO1187

Factors Contributing to Primary Care Provider (PCP) Use in ESKD Patients After Starting Hemodialysis (HD)

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Greer, Raquel C., National Kidney Foundation, New York, New York, United States
  • Ahn, JiYoon B., Johns Hopkins University, Baltimore, Maryland, United States
  • Plantinga, Laura, National Kidney Foundation, New York, New York, United States
  • Sperati, John, National Kidney Foundation, New York, New York, United States
  • Abdel-Kader, Khaled, National Kidney Foundation, New York, New York, United States
  • McAdams-DeMarco, Mara, Johns Hopkins University, Baltimore, Maryland, United States
  • Beers, Kelly H., National Kidney Foundation, New York, New York, United States
  • Soman, Sandeep S., National Kidney Foundation, New York, New York, United States
  • Choi, Michael J., National Kidney Foundation, New York, New York, United States
  • Jaar, Bernard G., National Kidney Foundation, New York, New York, United States

Group or Team Name

  • National Kidney Foundation Education Committee
Background

While the importance of primary care is well-recognized, PCP use among HD patients has not been well-characterized and factors contributing to PCP use are unknown.

Methods

We characterized change in PCP use (≥1 PCP visit) 1 year before and 1 year after dialysis start among adults ≥67 years old with Medicare coverage initiating in-center HD between 2008-2014 (data from the United States Renal Data System). We used multivariable logistic models adjusting for demographics, clinical characteristics, and pre-ESKD nephrology care to identify factors associated with continuity of PCP care (defined as PCP use pre- and post-HD start) and new initiation of PCP care post-HD start.

Results

Among 111,424 older HD patients, 34% did not use PCP care post-HD start. Among patients with PCP use pre-ESKD, 15% did not continue to use PCP care post-HD start. Among patients without PCP use pre-ESKD, 70% did not initiate PCP care post-HD start. Black race, Medicaid insurance, impaired functional status, and residence in less urban or higher poverty neighborhoods were associated with lower odds of continuity of PCP care or initiating PCP care after HD start. (Table)

Conclusion

Among older incident HD patients, continuity of PCP care and initiation of PCP care were lower among patients who were black, of lower socioeconomic status, from more rural areas, or had functional impairments. Research to understand the barriers to PCP use may inform interventions to improve delivery of primary care for these vulnerable populations.

Factors Associated with Continuity of PCP Care and Initiation of PCP Care after Starting HD
Patient CharacteristicsContinuity of PCP care after starting HD
(n=74253)
OR* (95% CI)
Initiation of PCP care
after starting HD
(n=37171)
OR* (95% CI)
Medicaid enrollment0.75 (0.71-0.790.73 (0.68-0.77)
Non-Hispanic Black (vs. Non-Hispanic White)0.83 (0.78-0.88)0.71 (0.66-0.75)
Functional impairment0.65 (0.61-0.68)0.90 (0.85-0.96)
% neighborhood-level poverty (tertiles)  
Medium (vs. low)0.89 (0.84-0.94)0.88 (0.83-0.93)
High (vs. low)0.85 (0.81-0.90)0.82 (0.77-0.87)
% neighborhood urban (tertiles)  
Medium (vs. low)1.28 (1.21-1.34)1.38 (1.30-1.46)
High (vs. low)1.20 (1.13-1.27)1.41 (1.32-1.50)

*Adjusted for variables in Table and age, sex, employment, co-morbid conditions (hypertension, diabetes, CVD, CHF, COPD, and cancer), US region, and pre-ESKD nephrology care

Funding

  • Private Foundation Support