Collaborative Care Between Transplant Nephrologists and Primary Care Physicians: A Gap Analysis.

Abstract

Background: Collaborative care between transplant centres and primary care physicians (PCP) is imperative for chronic disease management in kidney transplant recipients (KTR), but little training or guidelines has been developed specifically for PCP. There is a need to assess the quality and barriers to optimal delivery of primary care provided to KTR. Methods: Two self-administered questionnaires on the primary care management of KTR were developed and implemented. One survey investigated the perspectives of KTRs at an urban transplant centre on PCP performance, comfort level with their PCP, support received for self-management, and barriers to ideal care. The second survey targeted PCP of KTR assessing their attitudes and practice patterns towards similar domains in addition to their communication with transplant centres. Results: A total of 502 patients and 209 PCP completed the survey (response rate of 77% and 22%, respectively). The majority (76%) of patients indicated that a PCP was involved in their care. Patients felt comfortable receiving care for non-transplant related issues, vaccinations, and periodic health examinations from their PCP. Similarly, PCP felt comfortable providing such care. While only 23% of patients felt uncomfortable with their PCP managing their immunosuppressive medication, the majority (75.3%) of PCP felt uncomfortable. 73% of PCP responded that they were currently providing care to KTR. The majority of PCP specified that they rarely (57%) or never (20%) communicate with transplant centres. The most commonly stated barriers by PCP to delivering optimal care to KTR were insufficient guidelines provided by the transplant centre (68.9%) and lack of knowledge in managing KTR (58.8%). The resources suggested by PCP to improve their comfort level in managing KTR were written guidelines and continuing medical educational activities related to transplantation. Conclusions: Our results suggest that there is insufficient communication between the transplant centres, PCP, and patients. The methods for optimally providing such resources require further study. DISCLOSURES:Kim, S.: Grant/Research Support, Astellas Pharma Canada, Novartis Pharma Canada, Genzyme Canada.