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Samuel Silver, MD

Institution: Queen's University
Year: 2018-2021

Study title: Primary care physician involvement and quality of care for patients on dialysis

Lay Summary
Background: Patients on dialysis have high healthcare needs that go beyond their regular dialysis treatments. Therefore, their care also includes preventative health, symptom management, mental health, and acute illness. Given patients’ frequent presence in the dialysis unit, they may lose contact with their family doctor. The nephrologist is often asked to fill this gap and provide primary care despite little training dealing with issues that are more commonly handled by family doctors. This situation may lead to poor quality care. In other illnesses like diabetes and heart disease, patients who see their family doctors more often have better outcomes. No study has looked at whether the same applies to patients on dialysis, which could help change care for patients that respects patient time, healthcare provider expertise, and healthcare system costs.

Research Plan: The study aims are to describe the current role family doctors play for patients on dialysis, identify barriers to family doctor visits, and determine which processes and outcomes are improved by more frequent visits to a family doctor. To reach these goals, we will complete several studies using routinely collected patient and healthcare system information from 2003 to 2012 that is stored at the Institute for Clinical Evaluative Sciences (ICES) in Ontario, Canada. This data will allow us to compare patients with more family doctor visits to patients with fewer family doctor visits. We will look for an effect on care processes, (flu vaccination, cancer screening tests, and rehabilitation after a stroke or heart attack), selection of home dialysis, admission to hospital, and death.

Impact: My research program involves a stepwise approach to identify problems in healthcare that can then be targets for improvement:

  1. Identify problems with routinely collected health information
  2. Meet with patients and healthcare provides to develop solutions
  3. Test different solutions on a small-scale in real clinical practice
  4. Evaluate solutions on a larger scale, with a focus on studies that can be evaluated with routinely collected health information at ICES

This work will clarify the role that family doctors currently play for patients on dialysis and determine whether more contact with a family doctor improves patient outcomes. Once these studies are complete, future work will involve meeting with patients, family doctors, and nephrologists to discuss the results and develop strategies for better integration of the care provided to patients in dialysis programs and primary care settings.