Article Figures & Data
Tables
Additional Files
Supplemental Appendixes
Supplemental Appendix 1. Example of a Telenephrology Consultation; Supplemental Appendix 2. Dutch Interdisciplinary CKD-Guideline for Primary Care and Nephrology: Recommendations for the Care of Patients With CKD; Supplemental Appendix 3. The Family Physician's Intention to Refer Compared to the Nephrologist's Referral Advice Plotted Against the Dutch Interdisciplinary CKD-Guideline for Primary Care and Nephrology
Files in this Data Supplement:
- Supplemental data: Appendixes 1-3 - PDF file, 7 pages, 455 KB
The Article in Brief
Initial implementation of a Web-Based Consultation Process for Patients With Chronic Kidney Disease
Nynke D. Scherpbier-de Haan , and colleagues
Background A Web-based consultation system (telenephrology) enables family physicians to consult a nephrologist on a patient with chronic kidney disease: relevant data are exported from the electronic patient file to a protected digital environment from which advice can be formulated by the nephrologist. This study assesses the potential of telenephrology to reduce in-person referrals.
What This Study Found A Web-based consultation system between family physicians and nephrologists reduces the number of referrals and appears to improve treatment appropriateness among patients with chronic kidney disease. Analyzing 122 telenephrology consultations involving 116 patients, researchers found that in the absence of telenephrology, 43 patients (35 percent) would have been referred by their family physicians, whereas the nephrologist considered referral necessary in only 17 patients (14 percent) -- an 84 percent reduction. The opposite was seen in 10 patients, who according to clinicians could be treated in primary care but for whom the nephrologist deemed referral necessary. The time investment per consultation, most of which were performed during office hours, amounted to less than 10 minutes, and nephrologists' average response time was 1.6 days.
Implications
- The authors assert these findings support the introduction of telenephrology in primary care as a means of delivering higher quality, more convenient care at a lower cost. They conclude that on a broader scale, e-consultation has the potential to break down walls between primary and specialty care.