title: Associations of frequency and duration of patient-doctor contact in hemodialysis facilities with mortality.
abstract: It is unknown whether regular patient-doctor contact (PDC) contributes to better outcomes for patients undergoing hemodialysis. Here, we analyzed the associations between frequency and duration of PDC during hemodialysis treatments with clinical outcomes among 24,498 patients from 778 facilities in the international Dialysis Outcomes and Practice Patterns Study (DOPPS). The typical facility PDC frequency, estimated by facility personnel, was high (more than once per week) for 55% of facilities, intermediate (once per week) for 24%, and low (less than once per week) for 21%. The mean ± SD estimated duration of a typical interaction between patient and physician was 7.7 ± 5.6 minutes. PDC frequency and duration varied across DOPPS phases and countries; the proportion of facilities with high PDC frequency was 17% in the United States and 73% across the other countries. Compared with high PDC frequency, the adjusted hazard ratio (HR) for all-cause mortality was 1.06 (95% confidence interval [CI], 0.96 to 1.17) for intermediate PDC frequency and 1.11 (95% CI, 1.01 to 1.23) for low PDC frequency (P=0.03 for trend). Furthermore, each 5-minutes-shorter duration of PDC was associated with a 5% higher risk for death, on average (HR, 1.05; 95% CI, 1.01 to 1.09), adjusted for PDC frequency and other covariates. Multivariable analyses also suggested modest inverse associations between both PDC frequency and duration with hospitalization but not with kidney transplantation. Taken together, these results suggest that policies supporting more frequent and longer duration of PDC may improve patient outcomes in hemodialysis.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Hospital Organization Chiba-East Hospital, Japan. kawatake45@gmail.com
authors.forename: Takehiko
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Angelo
authors.initials: A
authors.lastname: Karaboyas
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Robinson
authors.forename: Yun
authors.initials: Y
authors.lastname: Li
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Brian A
authors.initials: BA
authors.lastname: Bieber
authors.forename: Hugh C
authors.initials: HC
authors.lastname: Rayner
authors.forename: Vittorio E
authors.initials: VE
authors.lastname: Andreucci
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Pisoni
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
authors.forename: Hal
authors.initials: H
authors.lastname: Morgenstern
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saran
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007391:International Cooperation; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome