Sec Hoong

Background The UK national chronic kidney disease (CKD) audit in primary care shows diagnostic coding in the electronic health record for CKD averages 70%, with wide practice variation. Coding is associated with improvements to risk factor management; CKD cases coded in primary care have lower rates of unplanned hospital admission. Aim To increase diagnostic coding of CKD (stages 3–5) and primary care management, including blood pressure to target and prescription of statins to reduce cardiovascular disease risk. Design and setting Controlled, cross-sectional study in four East London clinical commissioning groups (CCGs). Method Interventions to improve coding formed part of a larger system change to the delivery of renal services in both primary and secondary care in East London. Quarterly anonymised data on CKD coding, blood pressure values, and statin prescriptions were extracted from practice computer systems for 1-year pre- and post-initiation of the intervention. Results Three intervention CCGs showed significant coding improvement over a 1 year period following the intervention (regression for post-intervention trend P <0.001). The CCG with highest coding rates increased from 76–90% of CKD cases coded; the lowest coding CCG increased from 52–81%. The comparison CCG showed no change in coding rates. Combined data from all practices in the intervention CCGs showed a significant increase in the proportion of cases with blood pressure achieving target levels (difference in proportion P <0.001) over the 2-year study period. Differences in statin prescribing were not significant. Conclusion Clinically important improvements to coding and management of CKD in primary care can be achieved by quality improvement interventions that use shared data to track and monitor change supported by practice-based facilitation. Alignment of clinical and CCG priorities and the provision of clinical targets, financial incentives, and educational resource were additional important elements of the intervention.

10.3399/bjgp19x704105

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Do virtual renal clinics improve access to kidney care? an impact evaluation of a virtual clinic in east London

Research Square (Research Square) (2019)

Sally Hull Vian Rajabzadeh Nicola Thomas Sec Hoong Gavin Dreyer

Abstract BACKGROUND Evidence from the UK national chronic kidney disease (CKD) audit, identifies deficits in the identification and management of CKD within primary care. Aligning the requirement of GPs for a responsive nephrology service, with the capacity of renal services and the need to prioritise patients with progressive disease requires a re-think of traditional models of care. Utilising the health data in the primary care electronic health record (EHR) to bridge the primary secondary divide is one way forward. METHODS We describe a novel community kidney service based in the renal department at Barts Health NHS Trust and four clinical commissioning groups (CCGs) in east London. An impact evaluation of the changes in service delivery used quantitative data from the virtual CKD clinic and from the primary care electronic health records (EHR) of 166 participating practices. Survey and interview data from health professionals were used to explore changes to working practices. RESULTS Analysis of the virtual clinic data shows a rapid rise in referrals. The majority (>80%) do not require a traditional face to face appointment but can be managed with advice to the referring clinician. The wait for a nephrology opinion fell from 64 to 5 days. The age adjusted referral rate was 2.5 per 1000 registered patients. Primary care clinicians expressed positive views including the rapid response to clinical queries, increased confidence in CKD management, improved access for patients unable to travel to clinic, and reported patient satisfaction. Nephrologists valued seeing the entire clinical record which improved clinical advice, but had concerns about the volume of referrals and changes to working practices. CONCLUSIONS It is feasible to develop ‘virtual’ specialist services using shared access to the primary care EHR. Such services expand capacity to deliver timely advice based on a review of the entire EHR. To use both specialist and generalist expertise efficiently such services are best supported by community interventions which engage primary care clinicians in a data driven programme of service improvement.

Nephrology

10.21203/rs.2.12235/v3

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Do virtual renal clinics improve access to kidney care? A preliminary impact evaluation of a virtual clinic in East London

BMC Nephrology (2020)

Sally Hull Vian Rajabzadeh Nicola Thomas Sec Hoong Gavin Dreyer

Abstract Background Early identification of people with CKD in primary care, particularly those with risk factors such as diabetes and hypertension, enables proactive management and referral to specialist services for progressive disease. The 2019 NHS Long Term Plan endorses the development of digitally-enabled services to replace the ‘unsustainable’ growth of the traditional out-patient model of care.Shared views of the complete health data available in the primary care electronic health record (EHR) can bridge the divide between primary and secondary care, and offers a practical solution to widen timely access to specialist advice. Methods We describe an innovative community kidney service based in the renal department at Barts Health NHS Trust and four local clinical commissioning groups (CCGs) in east London. An impact evaluation of the changes in service delivery used quantitative data from the virtual CKD clinic and from the primary care electronic health records (EHR) of 166 participating practices. Survey and interview data from health professionals were used to explore changes to working practices. Results Prior to the start of the service the general nephrology referral rate was 0.8/1000 GP registered population, this rose to 2.5/1000 registered patients by the second year of the service. The majority (> 80%) did not require a traditional outpatient appointment, but could be managed with written advice for the referring clinician. The wait for specialist advice fell from 64 to 6 days. General practitioners (GPs) had positive views of the service, valuing the rapid response to clinical questions and improved access for patients unable to travel to clinic. They also reported improved confidence in managing CKD, and high levels of patient satisfaction. Nephrologists valued seeing the entire primary care record but reported concerns about the volume of referrals and changes to working practices. Conclusions ‘Virtual’ specialist services using shared access to the complete primary care EHR are feasible and can expand capacity to deliver timely advice. To use both specialist and generalist expertise efficiently these services require support from community interventions which engage primary care clinicians in a data driven programme of service improvement.

10.1186/s12882-020-1682-6

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Citations (22)

Do virtual renal clinics improve access to kidney care? an impact evaluation of a virtual clinic in east London

Research Square (Research Square) (2019)

Sally Hull Vian Rajabzadeh Nicola Thomas Sec Hoong Gavin Dreyer

Abstract BACKGROUND Evidence from the UK national chronic kidney disease (CKD) audit, identifies deficits in the identification and management of CKD within primary care. Aligning the requirement of GPs for a responsive nephrology service, with the capacity of renal services and the need to prioritise patients with progressive disease requires a re-think of traditional models of care. Utilising the health data in the primary care electronic health record (EHR) to bridge the primary secondary divide is one way forward. METHODS We describe a novel community kidney service based in the renal department at Barts Health NHS Trust and four clinical commissioning groups (CCGs) in east London. An impact evaluation of the changes in service delivery used quantitative data from the virtual CKD clinic and from the primary care electronic health records (EHR) of 166 participating practices. Survey and interview data from health professionals were used to explore changes to working practices. RESULTS Analysis of the virtual clinic data shows a rapid rise in referrals. The majority (>80%) do not require a traditional face to face appointment but can be managed with advice to the referring clinician. The wait for a nephrology opinion fell from 64 to 5 days. The age adjusted referral rate was 2.5 per 1000 registered patients. Primary care clinicians expressed positive views including the rapid response to clinical queries, increased confidence in CKD management, improved access for patients unable to travel to clinic, and reported patient satisfaction. Nephrologists valued seeing the entire clinical record which improved clinical advice, but had concerns about the volume of referrals and changes to working practices. CONCLUSIONS It is feasible to develop ‘virtual’ specialist services using shared access to the primary care EHR. Such services expand capacity to deliver timely advice based on a review of the entire EHR. To use both specialist and generalist expertise efficiently such services are best supported by community interventions which engage primary care clinicians in a data driven programme of service improvement.

Nephrology

10.21203/rs.2.12235/v1

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Do virtual renal clinics improve access to kidney care? an impact evaluation of a virtual clinic in east London

Research Square (Research Square) (2019)

Sally Hull Vian Rajabzadeh Nicola Thomas Sec Hoong Gavin Dreyer

Abstract BACKGROUND Evidence from the UK national chronic kidney disease (CKD) audit, identifies deficits in the identification and management of CKD within primary care. Aligning the requirement of GPs for a responsive nephrology service, with the capacity of renal services and the need to prioritise patients with progressive disease requires a re-think of traditional models of care. Utilising the health data in the primary care electronic health record (EHR) to bridge the primary secondary divide is one way forward. METHODS We describe a novel community kidney service based in the renal department at Barts Health NHS Trust and four clinical commissioning groups (CCGs) in east London. An impact evaluation of the changes in service delivery used quantitative data from the virtual CKD clinic and from the primary care electronic health records (EHR) of 166 participating practices. Survey and interview data from health professionals were used to explore changes to working practices. RESULTS Analysis of the virtual clinic data shows a rapid rise in referrals. The majority (>80%) do not require a traditional face to face appointment but can be managed with advice to the referring clinician. The wait for a nephrology opinion fell from 64 to 5 days. The age adjusted referral rate was 2.5 per 1000 registered patients. Primary care clinicians expressed positive views including the rapid response to clinical queries, increased confidence in CKD management, improved access for patients unable to travel to clinic, and reported patient satisfaction. Nephrologists valued seeing the entire clinical record which improved clinical advice, but had concerns about the volume of referrals and changes to working practices. CONCLUSIONS It is feasible to develop ‘virtual’ specialist services using shared access to the primary care EHR. Such services expand capacity to deliver timely advice based on a review of the entire EHR. To use both specialist and generalist expertise efficiently such services are best supported by community interventions which engage primary care clinicians in a data driven programme of service improvement.

Nephrology

10.21203/rs.2.12235/v2

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