A survey of nephrologists regarding their communication with transplant centers

Background: Patients with end-stage renal disease (ESRD) undergo a transition of care between their primary nephrologist and the transplant center during evaluation for kidney transplantation. Due to medical complexity, high hospitalization rate, and involvement of multiple medical stakeholders, transitions of medical care among patients with ESRD are likely to be associated with suboptimal care and medical errors. Provider-to-provider communication improves outcomes among ESRD patients transitioning between dialysis and transplant. There is little data analyzing proper transition of care between the nephrologist and the transplant center (TC). Objective: Using survey methodology, we examined nephrologists' current practice and experience regarding patient-related communication with the TC. Methods: From among 822 nephrologists who were following at least 20 ESRD patients, we randomly selected 252 nephrologists to participate in the study. The survey consisted of 102 multiple choice and Likert-style items probing perceptions about various aspects of transplant, including communication between TC and nephrologist. Responses from 216 participants who submitted complete responses were included in the final analysis. Results: Depending on the phase of transplant, nephrologist-TC communication varied between 50%-81% of nephrologists. Factors associated with higher likelihood of nephrologist-TC communication included attending transplant-related educational activity, practicing in a group with more than 5 nephrologists, and having more than 50 patients on dialysis. The majority of nephrologists indicated satisfaction with access to an attending physician in the TC, receiving timely and adequate information from the TC about their patients. Factors associated with higher likelihood of nephrologist satisfaction regarding communication with the TC included attending national nephrology meetings, medical directorship of a dialysis unit, fellowship training at an institution with an on-site transplant program, and availability of more than 2 transplant centers within 50 miles. Conclusion: There is a lack of evidence-based guidelines for patient transfer of care between nephrologists and transplant centers during various phases of transplant referral, evaluation and post-transplant care. We found that the likelihood of the nephrologists' communication with the transplant center and their satisfaction with the communication are related to their training, participation in continuing educational meetings, their practice location and size, and the overall composition of their patient population.