Interventions to Reduce Late Referrals to Nephrologists

Abstract

Background: Despite the adverse health outcomes with late nephrology referral for patients with chronic kidney disease (CKD), little is known about the underlying mechanisms and reasons for late referral patterns. Methods: We conducted a Medline search for peer-reviewed articles focused on nephrology referral among adults with CKD. We critically reviewed this literature in regard to late nephrology referral, highlighted its shortcomings, and provided a theoretically based framework for future research. Results: Late referral has been attributed to three key types of factors: primary care provider (PCP), patient, and healthcare system factors. Limited empirical research has pointed to knowledge deficits, perceptions, and preferences by PCPs as well as to knowledge deficits, psychological concerns, and economic concerns by patients. The existing literature is severely limited by retrospective designs, closed-ended surveys, and the absence of a theoretically driven conceptual framework to fully evaluate root causes of this ongoing problem. Social Cognitive Theory may be a particularly well-suited conceptual model for late nephrology referral because important PCP and patient factors correspond to key constructs of this theory. Conclusion: Future research is needed to delineate pathways underlying reasons for PCPs’ late referral patterns and CKD patients’ referral nonadherence. Interventions are urgently needed to reduce late referrals and improve the health of patients with CKD.

Prevalence of Chronic Kidney Disease in Patients with Spinal Cord Injuries/Disorders

“…type of system, access to nephrologists), and patient-related characteristics (e.g. sociodemographic factors, attitudes, knowledge) [34,36]. It is important to recognize that patients with SCI/D are a distinct population with unique needs for healthcare services and care coordination.…”

Implementing an evidence-based clinical decision support tool to improve the detection, evaluation, and referral patterns of adult chronic kidney disease patients in primary care

“…(), 16) Fischer et al. (), 17) Greer and Boulware (), 18) Kagoma et al. (), 19) Khan and Amedia (), 20) Komenda et al.…”

“…Knowledge of CKD and referral practice guidelines are lacking among PCPs and an estimated 30%–60% of PCPs are not aware of these specific guidelines (Fischer, Ahya, & Gordan, ; Greer, Powe, Jaar, Troll, & Boulware, ). Providers' negative perceptions about nephrology referral include poor coordination and correspondence with the nephrologist and ineffectiveness of referral (Fischer et al., ).…”

“…Knowledge of CKD and referral practice guidelines are lacking among PCPs and an estimated 30%–60% of PCPs are not aware of these specific guidelines (Fischer, Ahya, & Gordan, ; Greer, Powe, Jaar, Troll, & Boulware, ). Providers' negative perceptions about nephrology referral include poor coordination and correspondence with the nephrologist and ineffectiveness of referral (Fischer et al., ). PCPs’ considerations about nephrology referral include financial fear (loss of control or income and burden of referring patients to expensive subspecialty care), older age of the patient, noncompliance of the patient, and comorbid conditions of the patient (Fischer et al., ).…”

“…Providers' negative perceptions about nephrology referral include poor coordination and correspondence with the nephrologist and ineffectiveness of referral (Fischer et al., ). PCPs’ considerations about nephrology referral include financial fear (loss of control or income and burden of referring patients to expensive subspecialty care), older age of the patient, noncompliance of the patient, and comorbid conditions of the patient (Fischer et al., ). Patient risk factors for LNR include older age and nonwhite ethnicity, lack of health insurance, unemployment, and rapid progression of CKD (Fischer et al., ; Greer & Boulware, ).…”