Model of a Physician Group Practice on Hemodialysis Care in Thailand: A Cross-sectional Analysis of Clinical Outcomes
Chitranon Chan-on MD1, Pantipa Tonsawan MD1, Kittrawee Kritmetapak MD1, Sarassawan Kananuraks MD2, Dhavee Sirivongs MD1
Affiliation : 1 Nephrology Division, Internal Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand 2 Khon Kaen Hospital, Khon Kaen, Thailand
Objective : To test an effect of a model of physician group practice which five nephrologists have joined running an out-source
hemodialysis unit under common protocols since 2014.
Materials and Methods : Common protocols for how to deal with clinical problems and standing orders for emergency
conditions have been developed and regularly practiced. The physicians share responsibility and visit frequency to provide
at least twice a month for each patient. This retrospective review used records for point-prevalent patients receiving in-
center hemodialysis in March 2017. The situation of dialysis outcomes was reviewed.
Results : There were one hundred and nineteen cases continued on the treatment with mean age 60.3+12 years old, male to
female was 1:0.6. Dry weight was achieved at the end of sessions for 93.2% of patients, and only 5% gained weight more than
3.5 kgs/ session. The eighty-seven point three percent of patients achieved target Kt/V urea for either thrice- (1.2/session) or
twice- (1.8/session) weekly dialysis with mean Kt/V urea 1.88+0.39/ session. Patients reached target hemoglobin (>10 g/dL)
for 70.6% with mean hemoglobin 10.6+1.5 g/dL.
Conclusion : Most of clinical parameters are in acceptable range. It indicates that patient care by group practice is feasible
on aspects of patient safety and clinical satisfaction.
Keywords : hemodialysis outcome, nephrologist group practice, common protocol, hemodialysis protocol, hemodialysis visit frequency
