Associations of frequency and duration of patient-doctor contact in hemodialysis facilities with mortality

J Am Soc Nephrol. 2013 Sep;24(9):1493-502. doi: 10.1681/ASN.2012080831. Epub 2013 Jul 25.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cohort Studies
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • International Cooperation
  • Kidney Failure, Chronic / mortality*
  • Kidney Failure, Chronic / therapy*
  • Kidney Transplantation / statistics & numerical data
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Physician-Patient Relations*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Prospective Studies
  • Renal Dialysis*
  • Retrospective Studies
  • Survival Rate
  • Treatment Outcome