Online clinical pathway for managing adults with chronic kidney disease

Curtis, Craig; Balint, Carlee; Hamarneh, Yazid N. Al; Donald, Maoliosa; Tsuyuki, Ross T.; McBrien, Kerry; Jackson, Wes; Hemmelgarn, Brenda R.

doi:10.1177/1715163515597243

Cited by 16 publications

(21 citation statements)

References 43 publications

(40 reference statements)

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“…These provider concerns may stem from poor perceptions of patient self-efficacy and primary care in general and is consistent with other studies [26–31]. Although challenges related to identification and management of CKD patients in primary care have been reported [2], subsequent strategies to build CKD awareness, education, and access to specialist advice, such as an online CKD clinical pathway [32–34] and electronic access to specialist advice [35], have been implemented to build healthcare provider capacity to care for CKD patients in the community.…”

Section: Discussionsupporting

confidence: 74%

Patient and provider experience and perspectives of a risk-based approach to multidisciplinary chronic kidney disease care: a mixed methods study

et al. 2019

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Background The Kidney Failure Risk Equation (KFRE) predicts risk of progression to kidney failure and is used to guide clinical decisions for patients with chronic kidney disease (CKD). Methods The KFRE was implemented to guide access to multidisciplinary care for CKD patients in Alberta, Canada, based on their 2-year risk of kidney failure. We used a mixed methods approach to investigate patients’ and providers’ perspectives and experiences 1 year following KFRE implementation. We conducted post-implementation interviews with multidisciplinary clinic providers and with low-risk patients who transitioned from multidisciplinary to general nephrology care. We also administered pre- and post-implementation patient care experience surveys, targeting both low-risk patients discharged to general nephrology and high-risk patients who remained in the multidisciplinary clinic, and provider job satisfaction surveys. Results Twenty-seven interviews were conducted (9 patients, 1 family member, 17 providers). Five categories were identified among patients and providers: targeted care; access to resources outside the multidisciplinary clinics; self-efficacy; patient reassurance and reduced stress; and transition process for low-risk patients Two additional categories were identified among providers only: anticipated concerns and job satisfaction. Patients and providers reported that the risk-based approach allowed the clinic to target care to those most likely to experience kidney failure and most likely to benefit from multidisciplinary care. While some participants indicated the risk-based model enhanced the sustainability of the clinics, others expressed concern that care for low-risk patients discharged from multidisciplinary care, or those now considered ineligible, may be inadequate. Overall, 413 patients completed the care experience survey and 73 providers completed the workplace satisfaction survey. The majority of patients were satisfied with their care in both periods with no overall differences. When considering the responses “Always” and “Often” together versus not, there were statistically significant improvements in domains of access to care, caring staff, and safety of care. There were no differences in healthcare providers’ job satisfaction following KFRE implementation. Conclusions Patients and healthcare providers reported that the risk-based approach improved the focus of the multidisciplinary CKD clinics by targeting patients at highest risk, with survey results suggesting no difference in patient care experience or healthcare provider job satisfaction. Electronic supplementary material The online version of this article (10.1186/s12882-019-1269-2) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 74%

Patient and provider experience and perspectives of a risk-based approach to multidisciplinary chronic kidney disease care: a mixed methods study

et al. 2019

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“…An online clinical pathway 17 aims to build CKD-specific knowledge relating to patient identification, management, and appropriate referral targeting primary care and community pharmacy practitioners. 18 , 19 In addition, the recent integration of electronic nephrology consultation, 20 available to providers across the province, will facilitate access to nephrologist advice and enhance patient care. 21 These interventions will support primary care providers and may address participant concerns regarding the management of CKD care for low-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Perceived Benefits and Challenges of a Risk-Based Approach to Multidisciplinary Chronic Kidney Disease Care: A Qualitative Descriptive Study

Smekal

Tam-Tham

Finlay

et al. 2018

Can J Kidney Health Dis

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Background:The kidney failure risk equation (KFRE) provides an estimate of risk of progression to kidney failure, and may guide clinical care.Objective:We aimed to describe patient, family, and health care provider’s perspectives of the perceived benefits and challenges of using a risk-based approach to guide care delivery for patients with advanced chronic kidney disease (CKD), and refine implementation based on their input.Methods:We used qualitative methodology to explore perceived benefits and challenges of implementing a risk-based approach (using the KFRE) to determine eligibility for multidisciplinary CKD care in Southern Alberta. We obtained perspectives from patients and families through focus groups, as well as input from health care providers through interviews and open-ended responses from an online survey. Twelve patients/family members participated in 2 focus groups, 16 health care providers participated in an interview, and 40 health care providers responded to the survey.Results:Overall, participants felt that a KFRE-based approach had the potential to improve efficiency of the clinics by targeting care to patients at highest risk of kidney failure; however, they also expressed concerns about the impact of loss of services for lower risk individuals. Participants also articulated concerns about a perceived lack of capacity for adequate CKD patient care in the community. Our implementation strategy was modified as a result of participants’ feedback.Conclusions:We identified benefits and challenges to implementation of a risk-based approach to guide care of patients with advanced CKD. Based on these results, our implementation strategy has been modified by removing the category of referral back to primary care alone, and instead having that decision made jointly by nephrologists and patients among low-risk patients.

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“…4 For this reason, targeted and accessible screening of high-risk patients, such as those with hypertension, diabetes, family history of kidney disease and cardiovascular disease, is needed. 5 To this end, community pharmacists are at the forefront of primary care and in an optimal position to provide such targeted screening for CKD. Indeed, targeted screening, in conjunction with the implementation of the CKD Clinical Pathway, 5 is one initiative that has already been evaluated in Alberta, Canada.…”

Section: Introductionmentioning

confidence: 99%

“…5 To this end, community pharmacists are at the forefront of primary care and in an optimal position to provide such targeted screening for CKD. Indeed, targeted screening, in conjunction with the implementation of the CKD Clinical Pathway, 5 is one initiative that has already been evaluated in Alberta, Canada. 6 In that study, Al Hamarneh et al 6 used the pharmacists' authority to view, order and interpret laboratory tests 7 to screen 720 high-risk patients for CKD as per the CKD Clinical Pathway.…”

Section: Introductionmentioning

confidence: 99%

“…6 In that study, Al Hamarneh et al 6 used the pharmacists' authority to view, order and interpret laboratory tests 7 to screen 720 high-risk patients for CKD as per the CKD Clinical Pathway. 5 They found that 40% of those screened had CKD, and of those, 40% had previously unrecognized CKD (i.e., had no evidence of a previous CKD diagnosis). 6 Given that Alberta is the only province in Canada to grant pharmacists the authority to access and order laboratory tests, 8 point-of-care testing (PoCT) may present an alternative and practical way to expand CKD screening throughout the rest of Canada.…”

Section: Introductionmentioning

confidence: 99%

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Community pharmacist identification of chronic kidney disease using point-of-care technology: A pilot study

et al. 2020

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Online clinical pathway for managing adults with chronic kidney disease

Abstract: Practice GUiDeLiNeS PeeR-ReViewed

Cited by 16 publications

References 43 publications

Patient and provider experience and perspectives of a risk-based approach to multidisciplinary chronic kidney disease care: a mixed methods study

Patient and provider experience and perspectives of a risk-based approach to multidisciplinary chronic kidney disease care: a mixed methods study

Perceived Benefits and Challenges of a Risk-Based Approach to Multidisciplinary Chronic Kidney Disease Care: A Qualitative Descriptive Study

Community pharmacist identification of chronic kidney disease using point-of-care technology: A pilot study

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