| Perception of indications for nephrology referral among internal medicine residents: a national online survey. | |
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MedLine Citation:
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PMID: 19218472 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND OBJECTIVES: Many patients with chronic kidney disease (CKD) are seen by primary care physicians who may not be aware of indications or benefits of timely nephrologist referral. Late referral to a nephrologist may lead to suboptimal pre-end stage renal disease care and greater mortality. It is not known whether current postgraduate training adequately prepares a future internist in this aspect of CKD management. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: The authors performed an online questionnaire survey of internal medicine residents in the United States to determine their perceptions of indications for nephrology referral in CKD management. RESULTS: Four hundred seventy-nine residents completed the survey with postgraduate year (PGY) distribution of 166 PGY 1,187 PGY 2 and 126 PGY 3. Few residents chose nephrology referral for proteinuria (45%), uncontrolled hypertension (64%), or hyperkalemia (26%). Twenty-eight percent of the residents considered consulting a nephrologist for anemia of CKD, whereas 45% would do so for bone disorder of CKD. Most of the residents would involve a nephrologist at glomerular filtration rate (GFR) <30 ml/min/1.73 m(2) (90%) and for rapid decline in GFR (79%). Many residents would refer a patient for dialysis setup at GFR 15 to 30 ml/min/1.73 m(2) (59%); however, 18% would do so at GFR <15 ml/min/1.73 m(2). Presence of CKD clinic experience or an in-house nephrology fellowship program did not considerably change these perceptions. CONCLUSIONS: Results show that internal medicine residents have widely differing perceptions of indications for nephrology referral. Educational efforts during residency training to raise awareness and benefits of early referral may improve CKD management by facilitating better collaboration between internist and nephrologist. |
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Authors:
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Varun Agrawal; Amit K Ghosh; Michael A Barnes; Peter A McCullough |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Clinical journal of the American Society of Nephrology : CJASN Volume: 4 ISSN: 1555-905X ISO Abbreviation: Clin J Am Soc Nephrol Publication Date: 2009 Feb |
Date Detail:
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Created Date: 2009-02-16 Completed Date: 2009-06-11 Revised Date: 2010-09-22 |
Medline Journal Info:
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Nlm Unique ID: 101271570 Medline TA: Clin J Am Soc Nephrol Country: United States |
Other Details:
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Languages: eng Pagination: 323-8 Citation Subset: IM |
Affiliation:
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Department of Internal Medicine, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073, USA. varunagrawal1996@yahoo.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Attitude of Health Personnel Awareness Chronic Disease Clinical Competence Cooperative Behavior Cross-Sectional Studies Education, Medical, Graduate* / statistics & numerical data Glomerular Filtration Rate Health Care Surveys Health Knowledge, Attitudes, Practice* Humans Hyperkalemia / etiology Hypertension / etiology Interdisciplinary Communication Internal Medicine* / education, statistics & numerical data Internet Internship and Residency* / statistics & numerical data Kidney Diseases / complications, diagnosis*, epidemiology, physiopathology Nephrology* / education, statistics & numerical data Perception Physician's Practice Patterns* / statistics & numerical data Practice Guidelines as Topic Proteinuria / etiology Quality of Health Care Questionnaires Referral and Consultation* / statistics & numerical data United States / epidemiology |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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