Most CKD patient go to PCPs, who are less likely than other doctors to prescribe anemia drugs.


Only about one in 10 CKD-related outpatient visits for anemia management in the United States result in a prescription for an anemia medication, data show.

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In addition, the vast majority of CKD patient visits are to primary- care physicians (PCPs) and other non-nephrologist physicians.


Rajesh Balkrishnan, PhD, of the Ohio State University College of Pharmacy and School of Public Health in Columbus, and colleagues analyzed 1996-2002 data from the U.S. National Ambulatory Medical Care Survey (NAMCS).


The study sample included patients aged 18 years and older with CKD. All information provided in the NAMCS were office-visit level data that were analyzed using weighted estimation procedures to arrive at results that reflect statistics for the entire U.S. population.


From 1996 to 2002, there were 2,234 unweighted CKD-related outpatient visits, representing approximately 92 million weighted outpatient visits nationwide, the investigators reported in Clinical Therapeutics (2007;29:1524-1534). Most visits (63%) were made by women and patients aged 65 years and older (54%).


Only 18% of visits were to a nephrologist. Compared with patients 18-34 years old (the reference group), those aged 50-64 years were 4.36 times more likely to see a nephrologist. Medicare patients were nearly four times more likely than those with private insurance (reference group) to see a nephrologist.


Anemia was diagnosed in 48% of the CKD patients, but only 10% of these patients received a prescription for an anemia medication. PCPs were 79% less likely than non-PCPs to prescribe anemia drugs. Medicare patients were 51% less likely than patients with private insurance to be prescribed anemia drugs, the researchers noted.


In their discussion of study limitations, Dr. Balkrishnan and his colleagues pointed out that they were unable to verify if patients actually filled their prescription and to track any over-the-counter drugs that patients might have been receiving concomitantly.


In addition, the researchers said they could not as-certain if a physician consulted with another physician but did not refer the patient to that physician. The investigators also noted that they did not have access to patients’ CKD stage classification and they could not determine anemia severity. Thus, their basic assumption that patients “diagnosed” with anemia should be prescribed anemia medication might not represent optimal care, the authors wrote.