Impact of a phone app on nephrology referral

Abstract

Background Various factors can lead to inadequate nephrology referral decisions being taken by clinicians, but a major cause is unawareness of guidelines, recommendations and indications, or of appropriate timing. Today, tools such as smartphone applications (Apps) can make this knowledge more accessible to non-nephrologist clinicians. Our study aim is to determine the effectiveness of a purpose-built app in this respect. Methods In a retrospective study, nephrology referrals were compared before and after the introduction of the app in clinical practice. The initial study population consisted of first visits by patients referred to our department in 2015, before the introduction of the app. In 2016, the smartphone app NefroConsultor began to be implemented in our hospital. We compared the initial study population with the results obtained for patients referred in 2017, when the app was in use, taking into account clinical features considered, such as urinalysis, proteinuria or kidney ultrasound, to determine whether these patients met currently recommended criteria for referral. Results The total study population consisted of 628 patients, of whom 333 were examined before the introduction of the app (in 2015) and 295 when it was in use (in 2017). Among the first group, 132 (39.6%) met established KDIGO criteria for nephrology referral and were considered to be correctly referred. Among the second group, 200 (67.8%) met the criteria and were considered to be properly referred (P = 0.001). The increase in the rate of intervention success (before–after app) was 28.8% with a binomial effect size display (Cohen’s d effect size) of 0.751. Before the introduction of the app, data for albuminuria were included in 62.5% of nephrology referrals; in 2017, the corresponding value was 87.5% (P = 0.001). In the same line, referrals including urinalysis rose from 68.5% to 85.8% (P = 0.001). Multivariate regression analysis, using referrals meeting KDIGO criteria as the dependent variable and adjusting for age, sex and referring department, showed that the 2017 group (after the introduction of NefroConsultor) was associated with an odds ratio of 3.57 (95% confidence interval 2.52–5.05) for correct referrals, compared with the 2015 group (P = 0.001). References to proteinuria as the reason for nephrology referral also increased from 23.7% to 34.2% (P = 0.004). Conclusions Use of the app is associated with more frequent studies of albuminuria at the time of referral and a greater likelihood of proteinuria being cited as the reason for referral. The smartphone app considered can improve the accessibility of information concerning nephrology referrals and related studies.

Improved nephrology referral of chronic kidney disease patients: potential role of smartphone apps

“…The app collects data on age, gender, serum creatinine level, UACR and race, as well as ‘other reasons’ for referral, featured in the current referral criteria (Table 1). Based on these data, the software indicates whether patients meet SENEFRO and KDIGO criteria for nephrology referral, as recently reported in the Clinical Kidney Journal ( CKJ ) [12]. In this CKJ report, NefroConsultor improved the rate of adequate referrals to nephrology by 28%.…”

Impact of COVID-19 pandemic in Spanish Nephrology Servicesservices impact of the pandemic on COVID-19 Spanish Nephrology Services

“…The ability to adapt to telework and telemedicine in Nephrology opens a way to organize in a future virtual medicine in Nephrology, with cameras, webcam, apps and programs that facilitate a medical visit adapted to our patients with kidney disease. 8 , 9 , 10 The COVID-19 pandemic is probably the beginning of a paradigm shift in this regard. For many frail patients and their families, the trip to the hospital requires considerable effort and shows their clear preference for telemedicine even after the pandemic.…”

Risk-based versus GFR threshold criteria for nephrology referral in chronic kidney disease

“…Despite these limitations (Table 2 ), the risk of kidney failure may be a useful adjunct tool to clinical assessment as part of referral decision-making and encourage more albuminuria (or proteinuria) testing by primary care physicians. The use of the KFRE may incentivize the user to introduce albuminuria levels, as with the implementation of smartphone apps [ 31 ]. Additional studies to examine the impact of these risk thresholds, either 3% or 5% over 5 years, on the number of generated nephrology referrals and comparisons between new 2021 NICE criteria for referral and previous guidelines are needed [ 21 ].…”

“…This can lead to delayed intervention for treating kidney disease or an untimely referral [ 34 ]. An illustration can be the low rates of albuminuria (or proteinuria) testing in patients with CKD [ 27 , 35 ] in primary care and at the time of referral [ 31 ] despite the consistent recommendations and the vital importance of albuminuria (proteinuria) for prognostication in CKD.…”

“…Electronic health record reminders may help address low rates of albuminuria testing in patients with CKD. Smartphone apps may also help address these issues and facilitate the improvement in knowledge/awareness of CKD by primary care physicians and help to enable appropriate referral [ 31 , 36 ]. Automated laboratory reporting and the use of risk equations and clinical decision support tools could be embedded in existing electronic health records to guide the selection of individuals for testing and the frequency of repeat testing [ 29 ].…”