慢性肾脏病二级医疗保健的关键绩效指标:巴西圣保罗州公共和私营服务机构的经验。

IF 1.7 Q3 UROLOGY & NEPHROLOGY International Journal of Nephrology Pub Date : 2024-10-26 eCollection Date: 2024-01-01 DOI:10.1155/2024/5401633
Farid Samaan, Cristiane Akemi Vicente, Luiz Antônio Coutinho Pais, Gianna Mastroianni Kirsztajn, Ricardo Sesso
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引用次数: 0

摘要

简介本研究旨在评估慢性肾脏病(CKD)二级医疗保健的质量指标。研究方法这项回顾性纵向研究在巴西统一医疗系统(UHS)的一家肾脏病门诊部和一家私人医疗计划(PHP)的多学科门诊部进行。纳入标准为年龄≥ 18 岁,就诊次数≥ 3 次,随访时间≥ 6 个月。结果与 PHP 患者(人数 = 183)相比,UHS 患者(人数 = 276)年龄更大(63.4 岁对 59.7 岁,P=0.04),动脉高血压(AH)(91.7% 对 84.7%,P=0.02)和血脂异常(58.3% 对 38.3%,P<0.01),基线肾小球滤过率(eGFR)估计值较低(29.9 [21.5-42.0] 对 39.1 [28.6-54.8] mL/min/1.73 m2,P<0.01)。与 PHP 患者相比,UHS 患者中糖化血红蛋白小于 7.5% 的糖尿病患者比例较低(46.1% vs. 61.2%,p=0.03),血钾小于 5.5 mEq/L 的人数较少(90.4% vs. 95.6%,p=0.04),转诊进行血液透析且动静脉瘘 (AVF) 功能正常的人数较少(9.1% vs. 54.3%,p < 0.01)。高血压和血压 < 140 × 90 mmHg 患者的百分比在 UHS 组和 PHP 组之间相似(59.7% vs. 66.7%;P=0.17),甲状旁腺激素控制患者的百分比也相似(85.6% vs. 84.8%;P=0.01)。6% vs. 84.8%; p=0.83)、血脂异常和低密度脂蛋白胆固醇 < 100 mg/dL (38.3% vs. 49.3%; p=0.13)、磷 < 4.5 mg/dL (78.5% vs. 72.0%; p=0.16)、25-OH-维生素-D > 30 ng/mL (28.4% vs. 36.5%; p=0.11)。UHS 组 eGFR 的粗略下降幅度大于 PHP 组(2.3 [-0.1; 5.9] vs. 1.1 [-1.9; 4.6] mL/min/1.73 m2; p <0.01)。在多变量线性混合效应模型中,随着时间的推移,UHS 患者的 CKD 进展速度也快于 PHS 患者(组别效应,p < 0.01;时间效应,p < 0.01;交互效应,p < 0.01)。结论通过这两种服务可以提高对 CKD 患者的护理质量,多学科护理可能会对合并症的控制、CKD 的进展以及血液透析的启动规划产生积极影响。
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Key Performance Indicators of Secondary Health Care in Chronic Kidney Disease: Experience in Public and Private Services in the State of São Paulo, Brazil.

Introduction: The objective of this study was to evaluate quality indicators of secondary health care in chronic kidney disease (CKD). Methods: This retrospective longitudinal study was conducted in an outpatient medical nephrology clinic of the Brazilian Unified Health System (UHS) and a multidisciplinary outpatient clinic of a private health plan (PHP). The inclusion criteria were age ≥ 18 years, ≥ 3 medical appointments, and follow-up time ≥ 6 months. Results: Compared to PHP patients (n = 183), UHS patients (n = 276) were older (63.4 vs. 59.7 years, p=0.04), had more arterial hypertension (AH) (91.7% vs. 84.7%, p=0.02) and dyslipidemia (58.3 vs. 38.3%, p < 0.01), and had a lower estimated baseline glomerular filtration rate (eGFR) (29.9 [21.5-42.0] vs. 39.1 [28.6-54.8] mL/min/1.73 m2, p < 0.01). Compared to PHP patients, UHS patients had a lower percentage of diabetics with glycated hemoglobin < 7.5% (46.1% vs. 61.2%, p=0.03), fewer people with potassium < 5.5 mEq/L (90.4% vs. 95.6%, p=0.04), and fewer referrals for hemodialysis with functioning arteriovenous fistula (AVF) (9.1% vs. 54.3%, p < 0.01). The percentages of people with hypertension and blood pressure < 140 × 90 mmHg were similar between the UHS and PHP groups (59.7% vs. 66.7%; p=0.17), as was the percentage of people with parathyroid hormone control (85.6% vs. 84.8%; p=0.83), dyslipidemia and LDL-cholesterol < 100 mg/dL (38.3% vs. 49.3%; p=0.13), phosphorus < 4.5 mg/dL (78.5% vs. 72.0%; p=0.16), and 25-OH-vitamin-D > 30 ng/mL (28.4% vs. 36.5%; p=0.11). The crude reduction in eGFR was greater in the UHS group than in PHP (2.3 [-0.1; 5.9] vs. 1.1 [-1.9; 4.6] mL/min/1.73 m2; p < 0.01). In the multivariate linear mixed-effects model, UHS patients also showed faster CKD progression over time than PHS ones (group effect, p < 0.01; time effect, p < 0.01; interaction, p < 0.01). Conclusions: Quality of care for patients with CKD can be improved through both services, and multidisciplinary care may have a positive impact on the control of comorbidities, the progression of CKD, and the planning of the initiation of hemodialysis.

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来源期刊
International Journal of Nephrology
International Journal of Nephrology UROLOGY & NEPHROLOGY-
CiteScore
3.40
自引率
4.80%
发文量
44
审稿时长
17 weeks
期刊介绍: International Journal of Nephrology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies focusing on the prevention, diagnosis, and management of kidney diseases and associated disorders. The journal welcomes submissions related to cell biology, developmental biology, genetics, immunology, pathology, pathophysiology of renal disease and progression, clinical nephrology, dialysis, and transplantation.
期刊最新文献
The Protective Activity of Withania somnifera Against Mercuric Chloride (HgCl2)-Induced Renal Toxicity in Male Rats. Key Performance Indicators of Secondary Health Care in Chronic Kidney Disease: Experience in Public and Private Services in the State of São Paulo, Brazil. Matrix Gla Protein and Nitric Oxide Synthase-3 Genetic Variants in Chronic Kidney Disease and Their Relation with Cardiovascular Risk. Renal Manifestations of IgG4-Related Disease: A Concise Review. Bacteremia and Mortality among Patients with Nontunneled and Tunneled Catheters for Hemodialysis.
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