Quality of patient-physician discussions about CKD in primary care: a cross-sectional study

Abstract

Background: The quality of patient-physician discussions about chronic kidney disease (CKD) in primary care has not been studied previously.

Study design: Cross-sectional study.

Settings & participants: We audiotaped encounters between 236 patients with hypertension and their primary care physicians (n = 40).

Predictors: Patient, physician, and encounter characteristics.

Outcomes & measurements: We described the occurrence and characteristics (content, use of technical terms, and physician assessment of patient comprehension of new concepts) of CKD discussions. We assessed patient and physician characteristics associated with CKD discussion occurrence.

Results: Many patients (mean age, 59 years) had uncontrolled hypertension (51%), diabetes (44%), and/or 3 or more comorbid conditions (51%). Most primary care physicians practiced (52%) fewer than 10 years. CKD discussions occurred in few (26%; n = 61) encounters, with content focused on laboratory assessment (89%), risk-factor treatment (28%), and causes (26%) of CKD. In encounters that included a CKD discussion, physicians used technical terms (28%; n = 17) and rarely assessed patients' comprehension (2%; n = 1). CKD discussions were statistically significantly less common in visits of patients with some (vs no) college education (OR, 0.23; 95% CI, 0.09-0.56), with 3 or more (vs fewer) comorbid conditions (OR, 0.49; 95% CI, 0.25-0.96), and who saw physicians with more (vs fewer) than 10 years of practice experience (OR, 0.41; 95% CI, 0.21-0.80). CKD discussions were more common during longer encounters (OR, 1.31; 95% CI, 1.04-1.65) and encounters in which diabetes was (vs was not) discussed (OR, 2.87; 95% CI, 1.22-6.77).

Limitations: Generalizability of our findings may be limited.

Conclusions: Patient-physician discussions about CKD in high-risk primary care patients were infrequent. Physicians used technical terms and infrequently assessed patients' understanding of new CKD concepts. Efforts to improve the frequency and content of patient-physician CKD discussions in primary care could improve patients' clinical outcomes.

Figure 1

Topics of patient-physician discussions. We categorized the content of patient-physician discussions as pertaining to diabetes, hypertension, medication adherence, or chronic kidney disease (CKD) during visits. Categories were not mutually exclusive.