Quality of patient-physician discussions about CKD in primary care: a cross-sectional study.
BACKGROUND
The quality of patient-physician discussions about chronic kidney disease (CKD) in primary care has not been studied previously.


METHODS
Cross-sectional study.


METHODS
We audiotaped encounters between 236 patients with hypertension and their primary care physicians (n = 40).


METHODS
Patient, physician, and encounter characteristics.


METHODS
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).


CONCLUSIONS
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.
Division of General Internal Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Baltimore, MD 21287, USA. rfcharle@jhmi.edu
Raquel C
RC
Greer
Lisa A
LA
Cooper
Deidra C
DC
Crews
Neil R
NR
Powe
L Ebony
LE
Boulware
D002908:Chronic Disease; D003142:Communication; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007674:Kidney Diseases / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors