title: [Influence of physicians' subspecialty and training history on CKD management and medical cooperation: from the results of a nationwide questionnaire survey for primary care physicians].
abstract: OBJECTIVE
  The goal of this study was to elucidate how the subspecialty and training history of primary care physicians(PCPs) influence CKD management and medical cooperation in Japan.
  
  
  METHODS
  We conducted a nationwide questionnaire survey on CKD management for PCPs from December 2012 to March 2013. The questionnaire included 32 items about CKD management and medical cooperation. PCPs' subspecialties were categorized as follows: general internal medicine, nephrology, cardiology, diabetology/endocrinology, gastroenterology, pulmonology, neurology, neurosurgery, hematology, collagen disease/rheumatology, allergology. The PCPs' training history of nephrology was classified into three categories: none, experienced, active-nephrologist. Response distributions for each question were compared between the PCPs' subspecialties and the three categories of training history.
  
  
  RESULTS
  2,287 out of 28,200 PCPs (8.1%) of all 47 prefectures responded. The majority (86.5%) of responders were PCPs at clinics, and 90.9% were non-nephrologists. The PCPs' subspecialty influenced the response distributions in the following questions: utilization of the CKD guidebook, urinalysis at the first and follow-up examinations, frequency of blood testing, counselling with eGFR, self-monitoring of blood pressure, prescription and cessation of renin-angiotensin system (RAS) inhibitors, anemia treatment with erythropoiesis stimulating agents (ESA). The PCPs' training history of nephrology had a strong impact on various aspects of CKD management. The PCPs' subspecialties also influenced the responses regarding medical cooperation of CKD: relationship with nephrologists, utilization of critical path, criterion of patient referral, requests for nephrologists, discontent with the nephrologists' response.
  
  
  CONCLUSIONS
  We elucidated that the PCPs' subspecialty and training history of nephrology substantially influenced CKD management and medical cooperation in Japan. Effective promotion activities to improve CKD management and medical cooperation should be proposed on the basis of these data.
authors.affiliation: Renal/Electrolyte Division, Academic Committee, Japan Physicians Association.
authors.forename: Takero
authors.initials: T
authors.lastname: Naito
authors.affiliation: Renal/Electrolyte Division, Academic Committee, Japan Physicians Association.
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Ohtani
authors.affiliation: Renal/Electrolyte Division, Academic Committee, Japan Physicians Association.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Renal/Electrolyte Division, Academic Committee, Japan Physicians Association.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Miyazaki
authors.affiliation: Renal/Electrolyte Division, Academic Committee, Japan Physicians Association.
authors.forename: Kouji
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Japan Physicians Association, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sugawara
authors.affiliation: Japan Physicians Association, Tokyo, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Japan Physicians Association, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Saruta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004501:Education, Medical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires; D055815:Young Adult