Effect of primary care physicians' use of estimated glomerular filtration rate on the timing of their subspecialty referral decisions.
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BACKGROUND: Primary care providers' suboptimal recognition of the severity of chronic kidney disease (CKD) may contribute to untimely referrals of patients with CKD to subspecialty care. It is unknown whether U.S. primary care physicians' use of estimated glomerular filtration rate (eGFR) rather than serum creatinine to estimate CKD severity could improve the timeliness of their subspecialty referral decisions. METHODS: We conducted a cross-sectional study of 154 United States primary care physicians to assess the effect of use of eGFR (versus creatinine) on the timing of their subspecialty referrals. Primary care physicians completed a questionnaire featuring questions regarding a hypothetical White or African American patient with progressing CKD. We asked primary care physicians to identify the serum creatinine and eGFR levels at which they would recommend patients like the hypothetical patient be referred for subspecialty evaluation. We assessed significant improvement in the timing [from eGFR < 30 to ≥ 30 mL/min/1.73m(2)) of their recommended referrals based on their use of creatinine versus eGFR. RESULTS: Primary care physicians recommended subspecialty referrals later (CKD more advanced) when using creatinine versus eGFR to assess kidney function [median eGFR 32 versus 55 mL/min/1.73m(2), p < 0.001]. Forty percent of primary care physicians significantly improved the timing of their referrals when basing their recommendations on eGFR. Improved timing occurred more frequently among primary care physicians practicing in academic (versus non-academic) practices or presented with White (versus African American) hypothetical patients [adjusted percentage(95% CI): 70% (45-87) versus 37% (reference) and 57% (39-73) versus 25% (reference), respectively, both p ≤ 0.01). CONCLUSIONS: Primary care physicians recommended subspecialty referrals earlier when using eGFR (versus creatinine) to assess kidney function. Enhanced use of eGFR by primary care physicians' could lead to more timely subspecialty care and improved clinical outcomes for patients with CKD.
Glomerular Filtration Rate
Kidney Failure, Chronic
Physicians, Primary Care
Practice Patterns, Physicians'
Referral and Consultation
Published Version (Please cite this version)10.1186/1471-2369-12-1
Publication InfoGreer, Raquel C; Powe, Neil R; Jaar, Bernard G; Troll, Misty U; & Boulware, L Ebony (2011). Effect of primary care physicians' use of estimated glomerular filtration rate on the timing of their subspecialty referral decisions. BMC Nephrol, 12. pp. 1. 10.1186/1471-2369-12-1. Retrieved from https://hdl.handle.net/10161/8331.
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Nanaline Duke Distinguished Professor of Medicine
Dr. Boulware directs the Duke Clinical and Translational Science Institute as Vice Dean for Translational Science and Associate Vice Chancellor for Translational Research, and she is Chief of the Duke Division of General Internal Medicine in the Department of Medicine. She is a general internist, physician-scientist and clinical epidemiologist focused on improving health and health equity for individuals and communities affected by chronic health conditions such as kidney disease. A nati