Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2018 Nov 7;13(11):1659-1667.
doi: 10.2215/CJN.03170318. Epub 2018 Oct 18.

Patient Experience with Primary Care Physician and Risk for Hospitalization in Hispanics with CKD

Esteban A Cedillo-Couvert  1 , Jesse Y Hsu  2 , Ana C Ricardo  1 , Michael J Fischer  1   3 , Ben S Gerber  1 , Edward J Horwitz  4 , John W Kusek  5 , Eva Lustigova  6 , Amada Renteria  1 , Sylvia E Rosas  7 , Milda Saunders  8 , Daohang Sha  2 , Anne Slaven  4 , James P Lash  1 ; CRIC Study Investigators
Affiliations
Observational Study

Patient Experience with Primary Care Physician and Risk for Hospitalization in Hispanics with CKD

Esteban A Cedillo-Couvert et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: In the general population, the quality of the patient experience with their primary care physician may influence health outcomes but this has not been evaluated in CKD. This is relevant for the growing Hispanic CKD population, which potentially faces challenges to the quality of the patient experience related to language or cultural factors. We evaluated the association between the patient experience with their primary care physician and outcomes in Hispanics with CKD.

Design, setting, participants, & measurements: This prospective observational study included 252 English- and Spanish-speaking Hispanics with entry eGFR of 20-70 ml/min per 1.73 m2, enrolled in the Hispanic Chronic Renal Insufficiency Cohort study between 2005 and 2008. Patient experience with their primary care physician was assessed by the Ambulatory Care Experiences Survey subscales: communication quality, whole-person orientation, health promotion, interpersonal treatment, and trust. Poisson and proportional hazards models were used to assess the association between the patient experience and outcomes, which included hospitalization, ESKD, and all-cause death.

Results: Participants had a mean age of 56 years, 38% were women, 80% were primary Spanish speakers, and had a mean eGFR of 38 ml/min per 1.73 m2. Over 4.8 years (median) follow-up, there were 619 hospitalizations, 103 ESKD events, and 56 deaths. As compared with higher subscale scores, lower scores on four of the five subscales were associated with a higher adjusted rate ratio (RR) for all-cause hospitalization (communication quality: RR, 1.54; 95% confidence interval [95% CI], 1.25 to 1.90; health promotion: RR, 1.31; 95% CI, 1.05 to 1.62; interpersonal treatment: RR, 1.50; 95% CI, 1.22 to 1.85; and trust: RR, 1.57; 95% CI, 1.27 to 1.93). There was no significant association of subscales with incident ESKD or all-cause death.

Conclusions: Lower perceived quality of the patient experience with their primary care physician was associated with a higher risk of hospitalization.

Keywords: Ambulatory Care; Cause of Death; Female; Follow-Up Studies; Health Promotion; Hispanic Americans; Humans; Kidney Failure, Chronic; Language; Middle Aged; Physicians, Primary Care; Proportional Hazards Models; Prospective Studies; Renal Insufficiency, Chronic; Risk; Surveys and Questionnaires; glomerular filtration rate; hospitalization.

PubMed Disclaimer

Figures

None
Graphical abstract
Figure 1.
Figure 1.
The distribution of ACES scores varied by subscale.
Figure 2.
Figure 2.
Individuals with lower ACES subscales scores experienced higher hospitalization rates.
See this image and copyright information in PMC

Comment in

References

    1. US Renal Data System: United States Renal Data System 2016 Annual Data Report. Available at: https://www.usrds.org/2016/view/Default.aspx. Accessed April 30, 2017
    1. Holland DC, Lam M. Predictors of hospitalization and death among pre-dialysis patients: A retrospective cohort study. Nephrol Dial Transplant 15: 650–658, 2000 - PubMed
    1. Mix T-CH, St peter WL, Ebben J, Xue J, Pereira BJ, Kausz AT, Collins AJ: Hospitalization during advancing chronic kidney disease. Am J Kidney Dis 42: 972–981, 2003 - PubMed
    1. Xie Y, Bowe B, Xian H, Balasubramanian S, Al-Aly Z: Rate of kidney function decline and risk of hospitalizations in stage 3A CKD. Clin J Am Soc Nephrol 10: 1946–1955, 2015 - PMC - PubMed
    1. Wiebe N, Klarenbach SW, Allan GM, Manns BJ, Pelletier R, James MT, Bello A, Hemmelgarn BR, Tonelli M; Alberta Kidney Disease Network : Potentially preventable hospitalization as a complication of CKD: A cohort study. Am J Kidney Dis 64: 230–238, 2014 - PubMed

Publication types

MeSH terms