Referring patients with stable moderate-to-advanced chronic kidney disease back to primary care: a feasibility study
Background: Care for patients with chronic kidney disease (CKD) necessitates tailored pathways between primary and secondary care. It is unknown if back referring patients with CKD is safe and effective. Aim: To study the feasibility of discharging patients with stable moderate-to-advanced CKD from...
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| Format: | Article |
| Language: | English |
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Royal College of General Practitioners
2022-06-01
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| Series: | BJGP Open |
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| Online Access: | https://bjgpopen.org/content/6/2/BJGPO.2021.0177 |
| _version_ | 1818064278522953728 |
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| author | Carola van Dipten Wim de Grauw Marc ten Dam Willem Assendelft Nynke Scherpbier-de Haan Jack Wetzels |
| author_facet | Carola van Dipten Wim de Grauw Marc ten Dam Willem Assendelft Nynke Scherpbier-de Haan Jack Wetzels |
| author_sort | Carola van Dipten |
| collection | DOAJ |
| description | Background: Care for patients with chronic kidney disease (CKD) necessitates tailored pathways between primary and secondary care. It is unknown if back referring patients with CKD is safe and effective. Aim: To study the feasibility of discharging patients with stable moderate-to-advanced CKD from secondary to primary care, and to evaluate quality of care (QoC) and patients’ and GPs‘ experiences. Design & setting: A monocentre prospective mixed-method study in the Netherlands. Method: Patients were included who met pre-determined back-referral (BR) criteria. Patients were discharged with personalised information guides and transfer letters. GPs had the option of consulting a nephrologist by telenephrology. Renal outcomes, QoC, and experiences were collected after 1 year. Results: Eighteen patients were included. The mean age was 73 years; the mean estimated glomerular filtration rate (eGFR) was 33.2 ml/min/1.73 m2 at baseline. After 1 year, four patients had received either no or incomplete monitoring, and one patients’ blood pressure was too high. The remaining 13 had stable eGFR, proteinuria, and metabolic parameters. Patients were satisfied with information provision and treatment by GPs but expected more frequent monitoring. In one-third of cases, monitoring frequency was decreased by GPs for several reasons. GPs believed they had sufficient knowledge to treat patients with CKD, but indicated they needed support besides a transfer letter. Conclusion: BR seems safe and feasible for patients with stable moderate-to-advanced CKD who meet specific criteria. Patients have good renal outcomes after 1 year and are satisfied with treatment. GP QoC can be improved, particularly completeness and monitoring frequency. |
| first_indexed | 2024-12-10T14:33:27Z |
| format | Article |
| id | doaj.art-5d36bf442e6c4eeba0afc940b4200718 |
| institution | Directory Open Access Journal |
| issn | 2398-3795 |
| language | English |
| last_indexed | 2024-12-10T14:33:27Z |
| publishDate | 2022-06-01 |
| publisher | Royal College of General Practitioners |
| record_format | Article |
| series | BJGP Open |
| spelling | doaj.art-5d36bf442e6c4eeba0afc940b42007182022-12-22T01:44:53ZengRoyal College of General PractitionersBJGP Open2398-37952022-06-016210.3399/BJGPO.2021.0177Referring patients with stable moderate-to-advanced chronic kidney disease back to primary care: a feasibility studyCarola van Dipten0Wim de Grauw1Marc ten Dam2Willem Assendelft3Nynke Scherpbier-de Haan4Jack Wetzels5Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine, Canisius Wilhelmina Hospital, Nijmegen, The NetherlandsDepartment of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The NetherlandsBackground: Care for patients with chronic kidney disease (CKD) necessitates tailored pathways between primary and secondary care. It is unknown if back referring patients with CKD is safe and effective. Aim: To study the feasibility of discharging patients with stable moderate-to-advanced CKD from secondary to primary care, and to evaluate quality of care (QoC) and patients’ and GPs‘ experiences. Design & setting: A monocentre prospective mixed-method study in the Netherlands. Method: Patients were included who met pre-determined back-referral (BR) criteria. Patients were discharged with personalised information guides and transfer letters. GPs had the option of consulting a nephrologist by telenephrology. Renal outcomes, QoC, and experiences were collected after 1 year. Results: Eighteen patients were included. The mean age was 73 years; the mean estimated glomerular filtration rate (eGFR) was 33.2 ml/min/1.73 m2 at baseline. After 1 year, four patients had received either no or incomplete monitoring, and one patients’ blood pressure was too high. The remaining 13 had stable eGFR, proteinuria, and metabolic parameters. Patients were satisfied with information provision and treatment by GPs but expected more frequent monitoring. In one-third of cases, monitoring frequency was decreased by GPs for several reasons. GPs believed they had sufficient knowledge to treat patients with CKD, but indicated they needed support besides a transfer letter. Conclusion: BR seems safe and feasible for patients with stable moderate-to-advanced CKD who meet specific criteria. Patients have good renal outcomes after 1 year and are satisfied with treatment. GP QoC can be improved, particularly completeness and monitoring frequency.https://bjgpopen.org/content/6/2/BJGPO.2021.0177renal insufficiency, chronicback referralprimary health carepatient participationfeasibility studies |
| spellingShingle | Carola van Dipten Wim de Grauw Marc ten Dam Willem Assendelft Nynke Scherpbier-de Haan Jack Wetzels Referring patients with stable moderate-to-advanced chronic kidney disease back to primary care: a feasibility study BJGP Open renal insufficiency, chronic back referral primary health care patient participation feasibility studies |
| title | Referring patients with stable moderate-to-advanced chronic kidney disease back to primary care: a feasibility study |
| title_full | Referring patients with stable moderate-to-advanced chronic kidney disease back to primary care: a feasibility study |
| title_fullStr | Referring patients with stable moderate-to-advanced chronic kidney disease back to primary care: a feasibility study |
| title_full_unstemmed | Referring patients with stable moderate-to-advanced chronic kidney disease back to primary care: a feasibility study |
| title_short | Referring patients with stable moderate-to-advanced chronic kidney disease back to primary care: a feasibility study |
| title_sort | referring patients with stable moderate to advanced chronic kidney disease back to primary care a feasibility study |
| topic | renal insufficiency, chronic back referral primary health care patient participation feasibility studies |
| url | https://bjgpopen.org/content/6/2/BJGPO.2021.0177 |
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