About two-thirds (63%) of surveyed primary care providers correctly identified CKD in a hypothetical patient with CKD progressing to stage 4, compared to nearly all (96%) surveyed nephrologists.
Three-quarters (75%) of surveyed primary care providers recommended referral of the hypothetical CKD patient to a nephrologist, while nearly all (98%) surveyed nephrologists recommended referral.
Chart Explanation: Overall, 63.4% of primary care physicians correctly recognized CKD in the hypothetical patient. The figure shows that, of primary care physicians, general internists were better at recognizing CKD than the family practice physicians (70.8% vs. 56.2%, respectively). Nearly all nephrologists (96.0%) correctly recognized CKD in the patient. Most of the primary care providers (75%) responded that they would refer the patient to a nephrologist (similar for family practice physicians and general internists), compared to 98% of nephrologists.
In the period August 2005-August 2006, Boulware et al. (Boulware et al., 2006) conducted a national mail survey of 178 primary care providers (89 family physicians and 89 general internists; 28% response rate) and 126 nephrologists (39% response rate), identified with the American Medical Association Physician Masterfile. The questionnaire consisted of a hypothetical patient scenario, in which a primary care provider was evaluating a new patient with CKD stage 3 progressing to stage 4; the patient was identical for all cases (50-year-old female with creatinine values consistent with eGFR of 15-59 ml/min/1.73 m² and persistent proteinuria), except that her race/ethnicity (African-American or white) and comorbid illness status (hypertension only or hypertension with diabetes) varied by questionnaire. Physicians were asked to estimate the patient’s kidney function, and then were asked “How would you describe this patient’s kidney disease?” with possible responses of “normal or no kidney disease,” “mild kidney disease,” “moderate kidney disease,” “severe kidney disease,” and “end-stage kidney disease.” Responses of moderate or severe kidney disease were considered correct identification of CKD stage 3-4. Responding physicians were additionally asked: “Based on the information you know about this patient, do you recommend that the PCP refer the patient to a nephrologist at this time” with possible answers of “yes” or “no”.
As with all unweighted questionnaires the participants might not be representative of the targeted population.
|Description of Measure||Physician recognition and referral of CKD|
|Data Source||National cross-sectional survey of physicians 2005-2006|
|Type of Data Source||Private|
|Data Set||Survey results|
|Health Care System Data||No|
|Regional or National?||National|
|Demographic Group||178 primary care providers and 126 nephrologists identified from the AMA Masterfile|
|Numerator||Responding physicians who correctly identified a hypothetical stage 3-4 CKD patient as having CKD|
|Denominator||All responding physicians|
|Definition of CKD||eGFR of 15-59 and persistent albuminuria|
|Glomerular filtration rate||Calculated by respondent from creatinine|
|Proteinuria||Documented as persistent for hypothetical patient|
|Primary Data Source Indicator||Proportion of physicians correctly identified a hypothetical stage 3-4 CKD patient as having CKD|
|Primary Indicator Method of Measurement||Survey (mailed to a national random stratified sample of 1,200 physicians)|
|Frequency of Measurement (Primary)||Once (cross-sectional)|
|U.S. Region Covered by Primary Variable||All|
|Period Currently Available||2005–2006|
|Additional Data Items of Interest||Physician characteristics, preferences for referral|
|Limitations of Indicator||Low response rate to survey (28-39%), possible lack of generalizability; cross-sectional; survey may not reflect actual practices|
|Analytical Considerations||Test-retest reliability and consistency checks|
References and Sources:
Boulware LE, Troll MU, Jaar BG, Myers DI, Powe NR. Identification and referral of patients with progressive CKD: a national study. Am J Kidney Dis. 2006;48(2):192-204.