A published study suggests virtual services that use electronic health records — shared between specialists and primary care physicians — can improve the care patients with chronic kidney disease receive.
“Early identification of people with CKD in primary care, particularly those with risk factors such as diabetes and hypertension, enables proactive management and referral to specialist services for progressive disease,” Sally A. Hull, MD, of the Centre for Primary Care and Public Health at Queen Mary University of London, and colleagues wrote. “The 2019 NHS Long Term Plan endorses the development of digitally enabled services to preplace the ‘unsustainable’ growth of the traditional out-patient model of care. Shared views of the complete health data available in the primary care electronic health record (EHR) can bridge the divide between primary and secondary care, and offers a practical solution to widen timely access to specialist advice.”
Researchers described the service as being composed of three parts. These include the virtual CKD clinic (which provides a tool that allows nephrologists to view the complete primary care EHR and a tool that allows nephrologists to record notes and advice), a pack of IT tools (which enables practices to identify patients who would benefit from certain treatments and sends alerts to identify patients with falling eGFR) and renal education (which provides regular updates and case discussions for general practitioners and patient education sessions).
To test the impact of these services, researchers conducted an observational study of London-based primary care practices and the renal unit at Barts Health NHS Trust. Health professionals were also interviewed about their experiences with the services.
It was determined that, by the second year of the service, the general nephrology referral rate increased from 0.8 out of 1,000 patients to 2.5 out of 1,000 patients. Researchers noted that a traditional outpatient appointment was not required for more than 80% of patients, and that they could be managed with written advice for the referring clinician.
Further, after implementation of the services, the wait for a specialist fell from 64 to 6 days.
As for the response of health care professionals, the general practitioners saw the service positively and reported valuing the rapid response to clinical questions and improved access for patients unable to travel to the clinic, as well as improved confidence in managing CKD and high levels of patient satisfaction. Nephrologists also responded positively, appreciating the ability to see the full EHR, as well as quicker time to referral. However, some nephrologists were concerned about the lack of direct patient contact and the increasing volume of referrals.
The researchers argued that the intervention removed clinic barriers to effective assessment, including lost notes, transport delays, language barriers and patient non-attendance.
“The kidney service described here illustrates that it is feasible to develop ‘virtual’ specialist services by sharing access to the complete primary care EHR,” they wrote. “For such services to thrive they need support from community interventions which enlist primary care in a continuous process of service improvement, and hence can make best use of both specialist and generalist expertise.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.