Frequency of patient-physician contact in chronic kidney disease care and achievement of clinical performance targets

Int J Qual Health Care. 2005 Apr;17(2):115-21. doi: 10.1093/intqhc/mzi010. Epub 2005 Feb 21.


Objective: To examine whether the frequency of physician contact is associated with accepted quality of care measures reflecting clinical performance in chronic kidney disease patients.

Design: Prospective cohort study of end-stage renal disease patients begun in 1995, followed for 2.5 years.

Setting: 76 not-for-profit US dialysis clinics.

Study participants: 678 incident hemodialysis patients for whom we had information on average frequency of patient-physician contact at each clinic (low, monthly or less frequent; intermediate, between monthly and weekly; high, more than weekly), determined by clinic survey.

Main outcome measures: Achievement of accepted 6 month clinical performance targets of albumin (> or =3.5 g/dl), calcium-phosphate (Ca-P) product (<60 mg(2)/dl(2)), dialysis dose (Kt/V > or = 1.2), vascular access type (fistula), and hemoglobin (> or =11 g/dl).

Results: By logistic regression, patients treated at clinics reporting less frequent physician contact had lower odds of achieving most targets, statistically significantly for albumin [low, adjusted odds ratio (OR) = 0.83, 95% confidence interval (CI), 0.55-1.25; intermediate, adjusted OR = 0.62, 95% CI, 0.42-0.93; reference, high] and dialysis dose (low, adjusted OR = 0.26, 95% CI, 0.08-0.89; intermediate, adjusted OR = 0.67, 95% CI, 0.20-2.27); however, they had greater odds of achieving the hemoglobin target (low, adjusted OR = 1.94, 95% CI, 1.24-3.04; intermediate, adjusted OR = 1.89, 95% CI, 1.27-2.83). Additionally, the number of targets reached was statistically significantly lower in the monthly or less group (adjusted OR = 0.43, 95% CI, 0.20-0.94).

Conclusions: More frequent patient-physician contact is positively associated with the achievement of clinical performance targets in chronic kidney disease care.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Ambulatory Care Facilities / standards*
  • Appointments and Schedules
  • Female
  • Humans
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / therapy*
  • Logistic Models
  • Male
  • Middle Aged
  • Organizations, Nonprofit / standards
  • Outcome and Process Assessment, Health Care*
  • Physician-Patient Relations*
  • Prospective Studies
  • Quality Indicators, Health Care*
  • Renal Dialysis / standards*
  • Renal Dialysis / statistics & numerical data*
  • Surveys and Questionnaires
  • Time Factors