Improving Primary Care Delivery for Patients Receiving Maintenance Hemodialysis

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American journal of kidney diseases


The beneficial impact of primary care, focused on all aspects of a patients' health (rather than a disease-specific focus) is well established. Recognized benefits include greater receipt of preventive care and counseling, lower utilization of emergency care and hospitalization for ambulatory care sensitive conditions, and decreased early mortality. While the importance of primary care and care coordination at the primary care-specialty interface is well recognized, the role of primary care within traditional and emerging care models for patients receiving maintenance in-center hemodialysis remains ill-defined. In this perspective article, we will describe: 1) the role of primary care for patients receiving maintenance hemodialysis and the current evidence regarding the receipt of primary care among those patients; 2) the key challenges to delivery of primary care for these complex patients, including suboptimal care coordination between nephrology and primary care providers (PCPs), the intensity of dialysis care, and the limited capacity of nephrologists and PCPs to meet the broad health needs of hemodialysis patients; 3) the potential strategies for improving the delivery of primary care for patients receiving hemodialysis; and 4) future research needs to improve primary care delivery for this high-risk population.

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ePub ahead of print