Initial Implementation of a Web-Based Consultation Process for Patients With Chronic Kidney Disease

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.