2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Plantinga, L. C. Articles by Powe, N. R. Search for Related Content PubMed PubMed Citation Articles by Plantinga, L. C. Articles by Powe, N. R.

Frequency of Patient–Physician Contact and Patient Outcomes in Hemodialysis Care

Laura C. Plantinga^*, Nancy E. Fink^*,, John H. Sadler, Andrew S. Levey, Nathan W. Levin^¶, Haya R. Rubin^*,||, Josef Coresh^*,,#, Michael J. Klag^*,,|| and Neil R. Powe^*,,||

*Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Independent Dialysis Foundation, Baltimore, Maryland; Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts; ^¶Renal Research Institute, New York, New York; ^||Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ^#Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Correspondence to Dr. Neil R. Powe, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, 2024 E. Monument St., Suite 2-600, Baltimore, MD 21205. Phone: 410-955-6953; Fax: 410-955-0476;

ABSTRACT. There is little evidence supporting the widespread belief that regular patient–physician contact in chronic disease management leads to better patient outcomes. The objective of this study was to examine the relationship of the frequency of patient–physician contact with several patient outcomes in a prospective cohort study begun in 1995 of incident hemodialysis patients treated at 75 US dialysis clinics. Average frequency of patient–physician contact at each clinic was determined by clinic survey (low, monthly or less frequent; intermediate, between monthly and weekly; high, more than weekly). The authors used logistic, Poisson, and Cox proportional hazards regression analyses to assess the relationship between contact and satisfaction, quality of life, patient adherence, hospitalizations, and mortality. Of 735 hemodialysis patients, 14.3% were treated at clinics with high frequency of contact, 65.2% intermediate, and 20.5% low. Patients treated at clinics reporting less frequent physician contact had lower odds of rating the frequency at which they saw a nephrologist excellent (low: adjusted OR = 0.39, 95% CI, 0.23–0.67; intermediate: adjusted OR = 0.57, 95% CI, 0.37–0.87; reference, high) and greater odds of nonadherence (low: adjusted OR = 2.89, 95% CI, 1.01–8.29; intermediate: adjusted OR = 1.58, 95% CI, 0.78–3.19). However, patient survival did not vary by frequency of physician contact (low: adjusted RH = 0.87, 95% CI, 0.53–1.44; intermediate: adjusted RH = 1.33, 95% CI, 0.82–2.13), nor did patients’ overall ratings of care, hospitalization rates, or quality of life measures. Although less frequent patient–physician contact was associated with lower patient satisfaction with that contact and patient nonadherence, it was not associated with several other outcomes of care. Future studies are needed to assess the individual frequency and nature of physician contact over time, including total time spent with the patient and quality of the interaction, to guide the provision of patient-centered and cost-effective care. E-mail: npowe@jhmi.edu

This article has been cited by other articles:

				P. M. Just, F. Th. de Charro, E. A. Tschosik, L. L. Noe, S. K. Bhattacharyya, and M. C. Riella Reimbursement and economic factors influencing dialysis modality choice around the world Nephrol. Dial. Transplant., July 1, 2008; 23(7): 2365 - 2373. [Abstract] [Full Text] [PDF]

				A. A. Desai, A. M. Garber, and G. M. Chertow Rise of Pay for Performance: Implications for Care of People with Chronic Kidney Disease Clin. J. Am. Soc. Nephrol., September 1, 2007; 2(5): 1087 - 1095. [Abstract] [Full Text] [PDF]

				L. C. Plantinga, B. G. Jaar, N. E. Fink, J. H. Sadler, N. W. Levin, J. Coresh, M. J. Klag, and N. R. Powe Frequency of patient-physician contact in chronic kidney disease care and achievement of clinical performance targets Int. J. Qual. Health Care, April 1, 2005; 17(2): 115 - 121. [Abstract] [Full Text] [PDF]

				L. C. Plantinga, N. E. Fink, B. G. Jaar, J. H. Sadler, J. Coresh, M. J. Klag, A. S. Levey, and N. R. Powe Frequency of Sit-Down Patient Care Rounds, Attainment of Clinical Performance Targets, Hospitalization, and Mortality in Hemodialysis Patients J. Am. Soc. Nephrol., December 1, 2004; 15(12): 3144 - 3153. [Abstract] [Full Text] [PDF]

				J. Himmelfarb, B. J.G. Pereira, D. E. Wesson, P. C. Smedberg, and W. L. Henrich Payment for Quality in End-Stage Renal Disease J. Am. Soc. Nephrol., December 1, 2004; 15(12): 3263 - 3269. [Full Text] [PDF]

				T. A. Golper Frequency of Physician Visits to Patients on In-Center Maintenance Hemodialysis: Does One Strategy Fit All? J. Am. Soc. Nephrol., January 1, 2004; 15(1): 238 - 239. [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673