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

Abstract

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).

Publication lag in biomedical journals varies due to the periodical's publishing model

“…Observational studies can serve to generate a useful hypothesis, and often give similar results to more formal trials. [25][26][27][28] As most learned societies have contracts with commercial publishing houses which take care of the business and technical matters of their periodicals' publication process including procedures involved in the processing of manuscripts to published articles, many factors can possibly affect the publication speed. The slow publication may be due to the time spent on administrative procedures between the association and the publisher.…”

Interventions to Reduce Late Referrals to Nephrologists

“…Specifically, the provider literature is characterized by retrospective studies of clinical practice data, closed-ended surveys of PCPs, and the absence of theoretically driven models that explain the occurrence of late referral. Additionally, few studies assess PCP perspectives in depth or ascertain the association between the prevalence of PCP knowledge deficits or negative attitudes and late referral rates [24,29,45]. Regarding the patients’ perspective, little is known about correlates of patients’ nonadherence to nephrology referrals once such referrals have been requested by a PCP.…”

“…All three of these interventions focused on providers [45,49,50] with only one having also targeted patients [45]. Only one study of these studies was conducted in the US.…”

“…With regard to interventions for patients, Canadian multicenter randomized controlled trials of predialysis psychoeducational interventions were found to extend time to dialysis therapy by significant durations relative to usual care [45,50,58] and to increase survival of recipients by a median of 8.0 months longer than usual care after the initiation of dialysis therapy [58]. The psychoeducational interventions entailed educating patients about the normal functions of the kidneys, diseases of the kidneys, nutrition, medications, alternative modes of renal replacement therapy, and lifestyle, while also socializing patients into a collaborative role with service providers to foster increased involvement in self-care [58].…”

“…A German retrospective study found that timely referral by PCPs to nephrologists significantly increased over two years after educating PCPs about the health benefits of timely referral and treatment of CKD. Additionally, the intervention involved allaying PCPs’ fears that they would reap the economic burden of prescribing costly medications based on recommendations from nephrologists by having nephrologists provide drug prescriptions directly to patients [45]. …”