title: Primary care-specialist collaboration in the care of patients with chronic kidney disease.
abstract: OBJECTIVE
  Collaboration between primary care physicians (PCPs) and nephrologists in the care of patients with chronic kidney disease (CKD) is widely advocated, but physician preferences regarding collaboration are unknown. Physicians' desires to collaborate in the care of a hypothetical patient with CKD, their preferred content of collaboration, and their perceived barriers to collaboration were assessed.
  
  
  METHODS
  A questionnaire describing the care of a hypothetical patient with progressive CKD was administered to a national sample of U.S. PCPs and nephrologists. Physician characteristics and attitudes associated with desires to collaborate were identified.
  
  
  RESULTS
  Among 124 PCPs and 120 nephrologists, most physicians (85% PCPs versus 94% nephrologists) desired collaboration. Nephrologists were more likely than PCPs to prefer collaboration focus on predialysis/renal replacement therapy preparation and electrolyte management (73% versus 52% and 81% versus 46%, respectively). PCPs were more likely to desire collaboration if the hypothetical patient had diabetes and hypertension (versus hypertension alone), if they believed the care they provide helps slow CKD disease progression, and if they did not perceive health insurance as a barrier to nephrology referral (adjusted percentages [95% confidence interval]: 94% [80 to 98] versus 75% [reference]), 92% [75 to 98] versus 75% [reference], 42% [9 to 85] versus 88% [reference], respectively).
  
  
  CONCLUSIONS
  Most PCPs and nephrologists favored collaborative care for a patient with progressive CKD, but their preferred content of collaboration differed. Collaborative models that explicitly include PCPs in the care of patients with CKD may help improve patients' clinical outcomes.
authors.affiliation: University of Maryland School of Medicine, Medical Systems, 22 South Greene Street, Room N3W143, Baltimore, MD 21201, USA. cdiamantidis@medicine.umaryland.edu
authors.forename: Clarissa Jonas
authors.initials: CJ
authors.lastname: Diamantidis
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.forename: Raquel Charles
authors.initials: RC
authors.lastname: Greer
authors.forename: Misty U
authors.initials: MU
authors.lastname: Troll
authors.forename: L Ebony
authors.initials: LE
authors.lastname: Boulware
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003299:Cooperative Behavior; D018450:Disease Progression; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033183:Interdisciplinary Communication; D007674:Kidney Diseases / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D016017:Odds Ratio; D010348:Patient Care Team; D010465:Perception; D010819:Physician's Role; D011320:Primary Health Care; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014481:United States