Improving outpatient clinic experience: the future of chronic kidney disease care and associated multimorbidity.

Autor:	Al-Chalabi S; Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK saif.alchalabi@nca.nhs.uk.; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK., Alderson H; Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK., Garratt N; Research & Innovation, Northern Care Alliance NHS Foundation Trust, Salford, UK., Green D; Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK.; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK., Kalra PA; Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK.; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK., Ritchie J; Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK.; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK., Santhirasekaran S; Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK., Poulikakos D; Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK.; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK., Sinha S; Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK.; Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK.
Jazyk:	angličtina
Zdroj:	BMJ open quality [BMJ Open Qual] 2023 Aug; Vol. 12 (3).
DOI:	10.1136/bmjoq-2022-002188
Abstrakt:	Background: Chronic kidney disease (CKD) is estimated to affect more than 2.5 million adults in England, and this is expected to rise to 4.2 million by 2036 (1). Population-level digital healthcare systems have the potential to enable earlier detection of CKD providing an opportunity to introduce interventions that attenuate progression and reduce the risk of end-stage kidney disease (ESKD) and cardiovascular diseases (CVD). Services that can support patients with CKD, CVD, and diabetes mellitus (DM) have the potential to reduce fragmented clinical care and optimise pharmaceutical management. Methods and Results: The Salford renal service has established an outpatient improvement programme which aims to address these issues via two projects. Firstly, the development of a CKD dashboard that can stratify patients by their kidney failure risk equation (KFRE) risk. High-risk patients would be invited to attend an outpatient clinic if appropriate. Specialist advice and guidance would be offered to primary care providers looking after patients with medium risk. Patients with lower risk would continue with standard care via their primary care provider unless there was another indication for a nephrology referral. The CKD dashboard identified 11546 patients (4.4% of the total adult population in Salford) with T2DM and CKD. The second project is the establishment of the Metabolic CardioRenal (MRC) clinic. It provided care for 209 patients in the first 8 months of its establishment with a total of 450 patient visits. Initial analysis showed clustering of cardiorenal metabolic diseases with 85% having CKD stages 3 and 4 and 73.2% having DM. In addition, patients had a significant burden of CVD with 50.2% having hypertension and 47.8% having heart failure. Conclusion: There is a pressing need to create new outpatient models of care to tackle the rising epidemic of cardio-renal metabolic diseases. This model of service has potential benefits at both organisational and patient levels including improving patient management via risk stratification, increased care capacity and reduction of variation of care. Patients will benefit from earlier intervention, appropriate referral for care, reduction in CKD-related complications, and reduction in hospital visits and cardiovascular events. In addition, this combined digital and patient-facing model of care will allow rapid translation of advances in cardio-renal metabolic diseases into clinical practice. Competing Interests: Competing interests: JR reports conference registration and travel costs from Bayer. SS reports research funding from Amgen, Ethicon, and AstraZeneca; consultancy agreements with Sanifit and honoraria from Astra Zeneca, Napp Pharmaceuticals, Vifor Pharma, Novartis, Bayer, Sanofi-Genzyme, Travere and GSK. PAK reports speaker/lecture fees from AstraZeneca, Napp, Bayer, Novartis, Vifor Pharma, Pharmacosmos, Boehringer Ingelheim, Lilly, advisory Boards: AstraZeneca, Vifor Clinical consultancy: Bayer, Astellas, Otsuka, Unicyte. Grants: Astellas, Vifor, BergenBio, Evotec. DG reports speaker fees from AZ, Novartis, and Vifor Pharma. SA-C, SS, NG, and HA report no COI. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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