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Master Thesis

Insuffisance rénale chronique en EHPAD : prévalence, rôle des médecins généralistes, besoins et accès au néphrologue

Abstract : Background: chronic Kidney Disease (CKD) is common among older people but there are no studies of CKD prevalence in French nursing homes. Nursing home residents are probably less frequently referred to nephrologists. Objectives: to determine the prevalence of nursing home residents with potential indications for nephrologist referral, and the proportion of resident having access to this specialist. To describe difficulties and needs of general practitioners (GP) and nephrologists’ role in care for nursing home residents. To identify barriers to access to nephrologists. Methods: descriptive cross-sectional study of prevalence of potential indications for consultation with a nephrologist (estimated glomerular filtration rate (eGFR)<30 ml/min/1.73m2, or eGFR<45 ml/min/1.73m2 associated with: fast decline (>5 ml/min/1.73m2), complications, or risk of fast decline). Qualitative study of physicians’ semi-structured interviews. Team coding was used to identify themes from physician interviews. Results: among 500 residents in 5 nursing homes, 37 (7.4%, IC 95% [5,1-9,7]) had a potential indication for consultation with a nephrologist. Three patients were followed by this specialist. GP described referral to nephrologists as a very rare event in nursing home patients care. Main barriers to referral were patient dependence and comorbidities. Other barriers were GPs’ beliefs and knowledge in nephrology, nephrologist’s availability (in time and space), nursing home resources, and intercurrent events. Conclusions: potential indications for consultation with a nephrologist are not rare events among nursing home residents, but access to specialists remains uncommon. Barriers are related to patients, their GP and nephrologists. GP education and telemedicine are potential facilitators.
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Master Thesis
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Submitted on : Thursday, April 2, 2020 - 6:05:57 PM
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Camille Bodard. Insuffisance rénale chronique en EHPAD : prévalence, rôle des médecins généralistes, besoins et accès au néphrologue. Médecine humaine et pathologie. 2020. ⟨dumas-02530217⟩



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