Satisfaction Level among Nephrologists towards Chronic Kidney Disease Patients Referred from Primary Health Care System (original) (raw)
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BMC Research Notes, 2016
Background: Chronic kidney disease (CKD) is frequently unrecognized by non-nephrology physicians. There is an ongoing governmental program to create hemodialysis centers in the ten regions of Cameroon, where a previous study reported high levels of late referral to nephrologists. We aimed to assess the knowledge of physicians on CKD and their attitudes regarding referral. Methods: A questionnaire based on the Kidney Disease Outcome Quality Initiative Guidelines of 2002 was selfadministered to general practitioners and non-nephrology specialists working in two Cameroon cities that have hemodialysis centers (Douala and Bamenda). Results: Of the 174 general practitioners and non-nephrology specialists approached, 114 (65.5 %) returned answered questionnaires. Only 58.8 % of doctors identified the correct definition of CKD. Most physicians were aware of the major risk factors of CKD (hypertension, 97.4 % and diabetes mellitus, 95.6 %). Most physicians were also aware of complications such as anemia (93.0 %), hypertension (90.4 %), uremia (85.1 %) and hyperkalemia (85.1 %). Only 44 % knew that CKD had five stages, with general practitioners 3.4 times more likely to know than specialists (p = 0.004). Even though 61.4 % of the physicians knew that the estimated glomerular filtration rate was the appropriate clinical means to diagnose CKD, 12.7 % would use serum creatinine alone for diagnosis. Also, up to 21.9 % of physicians would refer at late stage. Conclusion: General practitioners and non-nephrology specialists lack general knowledge on CKD, especially on the definition and staging; they also have inadequate attitudes with regards to diagnosis and referral to the nephrologists. Educational efforts are warranted to improve on physicians' knowledge and skills on CKD in Cameroon.
Journal of nephrology, 2010
INTRODUCTION We conducted a survey interviewing end-stage renal disease (ESRD) patients just after they began chronic dialysis (CD) to describe characteristics and factors associated with early (ER) and late referral (LR), and to analyze the consequences of timing of referral to a nephrologist. METHODS We interviewed 673 patients via telephone starting CD between 2004 and 2006 in Lazio, Italy, to collect information about the year before CD. Multiple logistic regression was performed to evaluate the factors associated with LR. RESULTS We found that 22% of patients reported being LRs. A lower probability for LR was found for older age, family history of renal diseases, abnormal test for renal functions, presence of hypertension, married status and awareness of a nephrology outpatient center near home. LR patients had a lower frequency of hepatitis B virus (HBV) vaccination (14.9% vs. 41.7%), arteriovenous fistula (31.8% vs. 75.6%) and information about renal replacement therapy modal...
Clinical Journal of the American Society of Nephrology, 2008
Background and objectives: Many patients with chronic kidney disease (CKD) are seen by primary care physicians who may not be aware of indications or benefits of timely nephrologist referral. Late referral to a nephrologist may lead to suboptimal pre-end stage renal disease care and greater mortality. It is not known whether current postgraduate training adequately prepares a future internist in this aspect of CKD management.
Resident Doctors’ Knowledge and Practice of Chronic Kidney Disease: Diagnosis and Referral Pattern
Abstract Background: The prevalence of chronic kidney disease (CKD) in Nigeria is on the increase. Most patients with CKD present first to non-nephrologists and later to nephrologists with complications or in end stage renal disease (ESRD). To prevent early progression of CKD to ESRD, early diagnosis, optimal care and timely referral to nephrologists are crucial. The aim of this study is to assess the knowledge of CKD diagnosis, care and referral practices amongst resident doctors in Nigeria. Methods: Self administered questionnaires were distributed to resident doctors in diverse sub-specialties attending an update course on medical ethics organized by the West African College of Physicians in August 2013 at the main auditorium in University College Hospital, Ibadan Nigeria. The questionnaires were designed to elicit their knowledge of CKD diagnosis, common causes of CKD, screening of patients at risk of CKD, target blood pressure control and referral pattern. Results: Three hundre...
2004
Background: Late referral to specialist nephrological care is associated with increased morbidity, mortality, and cost. Consequently, nephrologists' associations recommend early referral. The recommendations' effectiveness remains questionable: 22-51% of referrals need renal replacement therapy (RRT) within 3-4 months. This may be due to these recommendations addressing the specialist, rather than the primary care providers (PCP). The potential of specialist intervention aiming at slowing progression of chronic renal failure was introduced individually to some 250 local PCPs, and referral strategies were discussed. To overcome the PCPs' most often expressed fears, every referred patient was asked to report back to his PCP immediately after the initial specialist examination, and new medications were prescribed directly, and thus allotted to the nephrologist's budget. Methods: In retrospective analysis, the stage of renal disease in patients referred within three months before the introductory round (group A, n = 18), was compared to referrals two years later (group B, n = 50). Results: Relative number of patients remained stable (28%) for mild/ moderate chronic kidney disease (MMCKD), while there was a noticeable shift from patients referred severe chronic kidney disease (SCKD) (group A: 44%, group B: 20%) to patients referred in moderate chronic kidney disease (MCKD) (group A: 28%, group B: 52%). Conclusion: Individually addressing PCPs' ignorance and concerns noticeably decreased late referral. This stresses the importance of enhancing the PCPs' problem awareness and knowledge of available resources in order to ensure timely specialist referral.
Measuring the Quality of Provided Services for Patients With Chronic Kidney Disease
Nephro-Urology Monthly, 2014
The healthcare organizations need to develop and implement quality improvement plans for their survival and success. Measuring quality in the healthcare competitive environment is an undeniable necessity for these organizations and will lead to improved patient satisfaction. Objectives: This study aimed to measure the quality of provided services for patients with chronic kidney disease in Kerman in 2014. Patients and Methods: This cross-sectional, descriptive-analytic study was performed from 23 January 2014 to 14 February 2014 in four hemodialysis centers in Kerman. All of the patients on chronic hemodialysis (n = 195) who were referred to these four centers were selected and studied using census method. The required data were collected using the SERVQUAL questionnaire, consisting of two parts: questions related to the patients' demographic characteristics, and 28 items to measure the patients' expectations and perceptions of the five dimensions of service quality, including tangibility, reliability, responsiveness, assurance, and empathy. The collected data were analyzed using SPSS 21.0 through some statistical tests, including independent-samples t test, one-way ANOVA, and paired-samples t test.
Renal Failure, 2011
Introduction: The quality of care provided to dialysis patients is under increasing scrutiny and systematic measurements of clinical performance, relying on indicators such as levels of Kt/V, hemoglobin, and serum albumin, have been implemented. Methods: In this retrospective study we revised clinical and laboratory data of 146 chronic hemodialysis (HD) patients who met our inclusion criteria in the dialysis unit at Prince Salman Center for Kidney Diseases for a whole year-2009. This study looked at the extent of adherence to the kidney diseases outcome quality initiative kidney diseases outcome quality initiative (K/DOQI), Centers for Disease Control and Prevention guidelines for prevention of transmission of infections among HD patients, and American Association of Medical Instrumentation standards for dialysis water quality. Results: A total of 146 HD patients (54.8% males and 45.2% females) were included in this study with mean age 51.21 ± 15.33 years. About 97.94% of cases had thrice-weekly sessions. An arteriovenous fistula was the vascular access in 78.1% of cases, and a permanent catheter was used in 21.9%. The mean predialysis blood pressure was ≤140/90 in 91.8% of cases. The mean hemoglobin level was 11.44 ± 1.46 g/dL in prevalent HD patients; 79.45% of cases had a hemoglobin level ≥11 g/dL. The mean serum albumin level was 33.53 ± 4.02 g/L; only 31.33% of cases had serum albumin ≥35 g/L. The mean parathormone level was 34.35 ± 28.70 pmol/L; 43.0% of patients had the target range (16.5-33 pmol/L), and the mean calcium level was 2.17 mmol/L; 89.73% of cases had the target range (2.12-2.52 mmol/L) while the mean serum phosphorus level was 1.46 mmol/L; 83.56% of patients had the target range (0.81-1.78 mmol/L). The Ca × Pi product was ≤4.5 in 83.56% of cases. The mean Kt/V value was 1.45 ± 0.18 in prevalent HD patients (98.63% and 60.96% of cases had Kt/V ≥1.2 and ≥ 1.4, respectively). All patients were negative for HIV serology test while the prevalence of hepatitis C virus-positive and hepatitis B virus-positive patients was 24.7% and 4.1%, respectively. All patients (except hepatitis B virus positive) were vaccinated against hepatitis B virus. The annual mortality rate was 5.67%. Conclusion: Our study revealed an excellent quality of care for HD patients in the field of vascular access care, hemoglobin level, blood pressure control, and dialysis adequacy. On the other hand, this study showed the need for improving the nutritional status of patients through more dietary counseling, nutritional education, and early management for nutritional problems.
Quality of chronic kidney disease management in primary care: a retrospective study
Scandinavian journal of primary health care, 2016
Early detection and appropriate management of chronic kidney disease (CKD) in primary care are essential to reduce morbidity and mortality. To assess the quality of care (QoC) of CKD in primary healthcare in relation to patient and practice characteristics in order to tailor improvement strategies. Retrospective study using data between 2008 and 2011 from 47 general practices (207 469 patients of whom 162 562 were adults). CKD management of patients under the care of their general practitioner (GP) was qualified using indicators derived from the Dutch interdisciplinary CKD guideline for primary care and nephrology and included (1) monitoring of renal function, albuminuria, blood pressure, and glucose, (2) monitoring of metabolic parameters, and alongside the guideline: (3) recognition of CKD. The outcome indicator was (4) achieving blood pressure targets. Multilevel logistic regression analysis was applied to identify associated patient and practice characteristics. Kidney function ...
2019
Recent changes to the health services have initiated a consumer-oriented approach to health care. The current national health strategy in Ireland "Quality and fairness: a health service for you" emphasises the principles of equity and fairness, a peoplecentred service, clear accountability and quality of care (Department of Health and Children, 2001). A consequence of these changes is the consideration of patient views of their health care, and this is often evaluated in the form of patient satisfaction studies. There is a growing realisation that patient input can give a greater understanding of the quality of services and how best to improve them.