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Kidney Week

Abstract: PO2055

Primary Care and Annual Wellness Visits Before and After Dialysis Initiation

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Wang, Virginia, Duke Univ, Durham, North Carolina, United States
  • Zepel, Lindsay, Duke Univ, Durham, North Carolina, United States
  • Diamantidis, Clarissa Jonas, Duke Univ, Durham, North Carolina, United States
  • Smith, Valerie A., Duke Univ, Durham, North Carolina, United States
  • Scholle, Sarah Hudson, NCQA, Washington, District of Columbia, United States
  • Maciejewski, Matthew L., Durham VAHCS, Durham, North Carolina, United States
Background

Demands of dialysis regimens may pose challenges for patients to receive care for the management of non-renal conditions. Dialysis initiation may affect primary care provider (PCP) engagement and timely preventive care. Provided mostly by PCPs, AWVs provide a unique opportunity outside of routine evaluation and management visits to reassess health risks and functional limitations, update care plans, screen for depression, and better coordinate care. AWVs may be particularly useful for older adults undergoing dialysis who usually have other chronic, non-renal needs that commonly require ongoing monitoring and management. This study examined variation and patient factors associated with having PCP care and receipt of AWVs before and after initiating dialysis.

Methods

We used de-identified data from the OptumLabs® Data Warehouse to conduct a cohort study of Medicare Advantage (MA) enrollees initiating dialysis in 2014-2017. We used logistic regression to examine whether MA enrollees had an outpatient visit with a PCP in the year after dialysis initiation and whether they received an AWV, adjusting for demographic characteristics, dialysis modality, comorbidity, and pre-dialysis care by a PCP or nephrologist.

Results

One year after dialysis initiation, 93.3% of MA enrollees had an outpatient PCP visit. They were more likely to see a PCP if they had seen a nephrologist (OR=1.60, 95% CI: 1.01-2.52) or a PCP (OR=15.65, 95% CI: 9.26-26.46) prior to initiation. They were less likely to see a PCP if they had lower comorbidity burden (Charlson score 0-5 vs 6-9: odds ratio (OR)=0.59, 95% CI: 0.37-0.95). Of MA enrollees initiating dialysis, 24.4% had an AWV. Hispanic MA enrollees were less likely (OR=0.57, 95% CI: 0.39-0.84) to have an AWV compared to White MA enrollees. Peritoneal dialysis patients (OR=1.54, 95% CI: 1.07-2.23) or those with an AWV in the year before dialysis (OR=4.96, 95% CI: 3.88-6.34) were more likely to have an AWV.

Conclusion

While nearly all MA enrollees saw a PCP in the year after dialysis initiation, few had an AWV in this pivotal year. Since most MA enrollees who initiated dialysis continue to see primary care providers, there is opportunity to increase access to AWVs for these complex patients, through patient education and awareness of the value of AWVs and by encouraging providers to offer AWVs.

Funding

  • Other U.S. Government Support