DIALYSIS PATIENT RATINGS OF THE QUALITY OF MEDICAL-CARE

Dialysis patients receive medical care from a variety of physicians. L ittle is known about how dialysis patients assess the quality of this care. We sought to determine (1) who dialysis patients receive medical care from, (2) how they rate the quality of such care, and (3) how ra tings differ for care provided by generalists, nephrologists, and othe r specialists. We performed a cross-sectional interview study of 148 p atients from four chronic hemodialysis units. Using a structured quest ionnaire, we asked subjects about each condition for which they receiv ed care in the preceding 12 months. For each condition, subjects menti oned the type of physician who provided care and then rated their over all satisfaction with care as well as six components of quality of car e (availability of doctor, technical skill, personal manner, explanati ons provided, amount of time spent, and how much patient was helped). We found that generalists, nephrologists, and other specialists provid ed care for 14%, 48%, and 38% of conditions for which patients receive d care. Sixty-nine percent of overall satisfaction ratings were very g ood or better. Of the six components of quality of care, explanations and amount of time received the lowest ratings. On multivariate analys is, increased patient age, black race, and care for acute illnesses we re associated with lower ratings of quality of care. There was no diff erence in ratings of care provided by generalists, nephrologists, and other specialists. In conclusion, dialysis patients receive most of th eir medical care from nephrologists and other specialists. Although th ey generally rate this care highly, we recommend that providers pay sp ecial attention to explanations provided, time spent with patients, an d care for acute illness. (C) 1998 by the National Kidney Foundation, Inc.