Out of the Shell: spreading renal knowledge into the community.

Abstract

Chronic kidney disease (CKD) is a fast-growing condition, highly underdiagnosed and not optimally managed. Nephrology knowledge is quite variable among Primary Care physicians (PCPs) and patients tend to ignore their condition and may find difficult to follow the appropriate recommendations. Traditional organization leaves Primary Care with the task of CKD detection and management of patients at initial stages of the disease. Whenever a PCP needs to seek advice, this can only be formally done by initiating a referral, which, in turn, may result in extending the waiting list. As Nephrology workforce is scare and not expected to grow, it is important to ensure that patients who benefit most from in-person nephrologist consultation receive timely care while those at lower risk of progression are attended in Primary Care according to guidelines. This PhD thesis evaluates the efficacy of a multifaceted intervention carried out along 10 years to avoid long waiting lists and ensure quick appropriate management of patients, consisting of a) a system of quick evaluation of referrals (referral filtering) that included the review of the patient’s electronic health records and the return of inadequate ones with a recommendation of management, b) the launch of an electronic consultation platform from PCPs to hospital nephrologists, c) developing and spreading clinical practice guidelines for CKD manage into PCPs, and d) an app to help CKD patients and caregivers with diet requirements (PUKONO). It also describes