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Active collaboration with primary care providers increases specialist referral in chronic renal disease

BACKGROUND: Late referral to specialist nephrological care is associated with increased morbidity, mortality, and cost. Consequently, nephrologists' associations recommend early referral. The recommendations' effectiveness remains questionable: 22–51% of referrals need renal replacement th...

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Autores principales: Mondry, Adrian, Zhu, Ai-Ling, Loh, Marie, Vo, Thuy D, Hahn, Kai
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2004
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC529261/
https://www.ncbi.nlm.nih.gov/pubmed/15498108
http://dx.doi.org/10.1186/1471-2369-5-16
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author Mondry, Adrian
Zhu, Ai-Ling
Loh, Marie
Vo, Thuy D
Hahn, Kai
author_facet Mondry, Adrian
Zhu, Ai-Ling
Loh, Marie
Vo, Thuy D
Hahn, Kai
author_sort Mondry, Adrian
collection PubMed
description BACKGROUND: Late referral to specialist nephrological care is associated with increased morbidity, mortality, and cost. Consequently, nephrologists' associations recommend early referral. The recommendations' effectiveness remains questionable: 22–51% of referrals need renal replacement therapy (RRT) within 3–4 months. This may be due to these recommendations addressing the specialist, rather than the primary care providers (PCP). The potential of specialist intervention aiming at slowing progression of chronic renal failure was introduced individually to some 250 local PCPs, and referral strategies were discussed. To overcome the PCPs' most often expressed fears, every referred patient was asked to report back to his PCP immediately after the initial specialist examination, and new medications were prescribed directly, and thus allotted to the nephrologist's budget. METHODS: In retrospective analysis, the stage of renal disease in patients referred within three months before the introductory round (group A, n = 18), was compared to referrals two years later (group B, n = 50). RESULTS: Relative number of patients remained stable (28%) for mild/ moderate chronic kidney disease (MMCKD), while there was a noticeable shift from patients referred severe chronic kidney disease (SCKD) (group A: 44%, group B: 20%) to patients referred in moderate chronic kidney disease (MCKD) (group A: 28%, group B: 52%). CONCLUSION: Individually addressing PCPs' ignorance and concerns noticeably decreased late referral. This stresses the importance of enhancing the PCPs' problem awareness and knowledge of available resources in order to ensure timely specialist referral.
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spelling pubmed-5292612004-11-19 Active collaboration with primary care providers increases specialist referral in chronic renal disease Mondry, Adrian Zhu, Ai-Ling Loh, Marie Vo, Thuy D Hahn, Kai BMC Nephrol Research Article BACKGROUND: Late referral to specialist nephrological care is associated with increased morbidity, mortality, and cost. Consequently, nephrologists' associations recommend early referral. The recommendations' effectiveness remains questionable: 22–51% of referrals need renal replacement therapy (RRT) within 3–4 months. This may be due to these recommendations addressing the specialist, rather than the primary care providers (PCP). The potential of specialist intervention aiming at slowing progression of chronic renal failure was introduced individually to some 250 local PCPs, and referral strategies were discussed. To overcome the PCPs' most often expressed fears, every referred patient was asked to report back to his PCP immediately after the initial specialist examination, and new medications were prescribed directly, and thus allotted to the nephrologist's budget. METHODS: In retrospective analysis, the stage of renal disease in patients referred within three months before the introductory round (group A, n = 18), was compared to referrals two years later (group B, n = 50). RESULTS: Relative number of patients remained stable (28%) for mild/ moderate chronic kidney disease (MMCKD), while there was a noticeable shift from patients referred severe chronic kidney disease (SCKD) (group A: 44%, group B: 20%) to patients referred in moderate chronic kidney disease (MCKD) (group A: 28%, group B: 52%). CONCLUSION: Individually addressing PCPs' ignorance and concerns noticeably decreased late referral. This stresses the importance of enhancing the PCPs' problem awareness and knowledge of available resources in order to ensure timely specialist referral. BioMed Central 2004-10-22 /pmc/articles/PMC529261/ /pubmed/15498108 http://dx.doi.org/10.1186/1471-2369-5-16 Text en Copyright © 2004 Mondry et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open-access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Mondry, Adrian
Zhu, Ai-Ling
Loh, Marie
Vo, Thuy D
Hahn, Kai
Active collaboration with primary care providers increases specialist referral in chronic renal disease
title Active collaboration with primary care providers increases specialist referral in chronic renal disease
title_full Active collaboration with primary care providers increases specialist referral in chronic renal disease
title_fullStr Active collaboration with primary care providers increases specialist referral in chronic renal disease
title_full_unstemmed Active collaboration with primary care providers increases specialist referral in chronic renal disease
title_short Active collaboration with primary care providers increases specialist referral in chronic renal disease
title_sort active collaboration with primary care providers increases specialist referral in chronic renal disease
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC529261/
https://www.ncbi.nlm.nih.gov/pubmed/15498108
http://dx.doi.org/10.1186/1471-2369-5-16
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