Introduction The ASSIST-CKD project is a national quality improvement programme, aiming to decrease the number of patients presenting late to renal services by enabling laboratories to review up to five years of estimated glomerular filtration rate results graphically and report deteriorating patients to their general practitioner. Aim To assess the impact of the project on the laboratory, and of patient reporting on general practitioner management and the local renal service. Method Each week two searches were performed (Search A: maximum age 65 years, maximum eGFR 50 ml/min/1.73 m 2 and Search B: Age 66–120 years, maximum eGFR 40 ml/min/1.73 m 2 ) on patients with an estimated glomerular filtration rate requested by their general practitioner within the previous seven days. Patients showing deterioration in estimated glomerular filtration rate had a printed graph sent to their general practitioner. Feedback on the graphs and their impact on patient management were obtained from the general practitioners via a questionnaire. Results A median of 37 patients/week were listed for review for Search A, with 32% reported; and Search B a median of 227 patients/week listed, 32% reported. General practitioner surgery questionnaires (29) showed the reports were well received. Of general practitioners responding to the questionnaire, 67% had reviewed a patient earlier than intended, 54% had reviewed local guidance, 48% had emailed the renal team and 48% had referred a patient on receipt of a graph; 34% had shown a graph to their patients, of whom 70% found that useful. Conclusion There is some evidence that ASSIST-CKD reporting has enhanced patient care; however, further long-term assessment is still required.
Abstract Background The coronavirus disease 2019 (COVID‐19) pandemic resulted in a rapid and sometimes chaotic change in how clinical care was delivered for people living with kidney disease, with increased reliance on digital technologies and the introduction of remote services. Objectives To conduct a scoping review of studies about patients' experiences and perspectives in receipt of remote consultations for kidney care. Design Using Arksey and O'Malley's framework, three databases were searched on EBSCO (CINAHL, MEDLINE and Psych INFO). The search included studies published in English from August 2010 to August 2021. Results Eight studies met the scoping review criteria (two cross‐sectional, two mixed‐method and four qualitative). Five themes were identified: overall satisfaction with remote services, benefits to patients (convenience, involvement in care and patient safety), barriers to remote consultations (technical difficulties, digital literacy and loss of interpersonal communication), patient concerns (need for physical examination, privacy and confidentiality) and prerequisites for successful remote care (existing patient–practitioner relationship, stable illness phase and access to technology). Conclusion Remote consultations confer multiple advantages to patients; therefore, remote consultations should be offered as an option to patients living with kidney disease beyond the COVID‐19 pandemic. However, there are several barriers to remote consultation that need to be addressed and understood before implementing remote care long‐term. Future research should examine the impact of remote consultations on people living with kidney disease from under‐served groups to identify barriers and ensure their suitability and accessibility to the wider population for a more patient‐centred approach to kidney care.
Introduction. This qualitative descriptive study was designed to understand the experiences of older people (>70 years) when making a decision about renal replacement therapy. This was a coproduced study, whereby patients and carers were involved in all aspects of the research process. Methods. A Patient and Carer Group undertook volunteer and research training. The group developed the interview questions and interviewed 29 people who had commenced dialysis or made a decision not to have dialysis. Interview data were transcribed and analysed, and common themes were identified. Results. 22 men and 7 women (mean age 77.4 yrs) from two hospitals were interviewed. 18 had chosen haemodialysis, 6 peritoneal dialysis, and 5 supportive care. The majority of patients were involved in the dialysis decision. Most were satisfied with the amount of information that they received, although some identified that the quality of the information could be improved, especially how daily living can be affected by dialysis. Conclusion. Our findings show that overall older patients were involved in the dialysis decision along with their families. Our approach is innovative because it is the first time that patients and carers have been involved in a coproduced study about shared decision-making.
Abstract Background Kidney transplantation in older people has increased, however older transplant recipients experience mixed outcomes that invariably impacts on their quality of life. The increased vulnerability of older end stage kidney disease patients to frailty and cognitive impairment may partially explain the differences in outcomes observed. The Kidney Transplantation in Older People (KTOP): impact of frailty on clinical outcomes study is an active clinical study aiming to explore the experience of older people waiting for and undergoing transplantation. In this manuscript we present the study protocol, the study cohort, and the prevalence of frailty and cognitive impairment identified at recruitment. Methods The KTOP study is a single centre, prospective, mixed methods, observational study. Recruitment began in October 2019. All patients aged 60 or above either active on the deceased donor waitlist or undergoing live donor transplantation were eligible for recruitment. Recruited participants completed a series of questionnaires assessing frailty, cognition, and quality of life, which are repeated at defined time points whilst on the waitlist and post-transplant. Clinical data was concurrently collected. Any participants identified as frail or vulnerable to frailty were also eligible for enrolment into the qualitative sub-study. Results 208 participants have been recruited (age 60-78). Baseline Montreal Cognitive Assessments were available for 172 participants, with 72 (41.9%) participants identified as having scores below normal (score <26). Edmonton Frail Scale assessments were available for 184 participants, with 30 participants (16.3%) identified as frail (score ³8), and a further 37 participants (20.1%) identified as being vulnerable to frailty (score 6-7). Conclusion In the KTOP study cohort we have identified a prevalence of 41.9% of participants with MoCA scores suggestive of cognitive impairment, and a prevalence of frailty of 16.3% at recruitment. A further 20.1% were vulnerable to frailty. As formal testing for cognition and frailty is not routinely incorporated into the work up of older people across many units, the presence and significance of these conditions is likely not known. Ultimately the KTOP study will report on how these parameters evolve over time and following a transplant, and describe their impact on quality of life and clinical outcomes.
Over the past 10 years, chronic kidney disease (CKD) has become known as a common long-term condition, that affects around 13% of adults worldwide (1). CKD is defined as abnormalities of kidney structure or function, present for more than 3 months, and classified into five stages (2) using a blood test for estimated glomerular filtration rate (eGFR) and also a urine test for albumin–creatine ratio (ACR). To accurately diagnose CKD and improve health outcomes, it is important that both blood and urine tests are performed. CKD is associated with an increased risk of cardiovascular disease and also an increased risk for progression to advanced kidney disease that requires renal replacement therapy (dialysis or transplantation)
Abstract Background Telephone and video appointments are still common post‐pandemic, with an estimated 25%–50% of kidney appointments in the United Kingdom still conducted remotely. This is important as remote consultations may exacerbate pre‐existing inequalities in those from underserved groups. Those from underserved groups are often not represented in health research and include those with learning disability, mental health needs, hearing/sight problems, young/older people, those from ethnic minority groups. Objectives The aim was to develop a Toolkit to improve the quality of remote kidney care appointments for people from different underserved groups. Design A parallel mixed methods approach with semistructured interviews/focus groups and survey. We also conducted workshops to develop and validate the Toolkit. Participants Seventy‐five renal staff members completed the survey and 21 patients participated in the interviews and focus groups. Patients ( n = 11) and staff ( n = 10) took part in the Toolkit development workshop, and patients ( n = 13) took part in the Toolkit validation workshop. Results Four themes from interviews/focus groups suggested areas in which remote appointments could be improved. Themes were quality of appointment, patient empowerment, patient–practitioner relationship and unique needs for underserved groups. Staff reported difficulty building rapport, confidentiality issues, confidence about diagnosis/advice given, technical difficulties and shared decision making. Conclusion This study is the first to explore experiences of remote appointments among both staff and those from underserved groups living with kidney disease in the United Kingdom. While remote appointments can be beneficial, our findings indicate that remote consultations need optimisation to meet the needs of patients. The project findings informed the development of a Toolkit which will be widely promoted and accessible in the United Kingdom during 2024.
Background Early identification of people with chronic kidney disease (CKD) in primary care, enables proactive clinical management. CKD trigger tools designed as patient safety tools, alert GP practices when falling estimated glomerular filtration rates (eGFR) are identified from the patient record. The tool’s aim is to alert clinicians to possible CKD progression, and invites written reflection by the GP of the ‘referral’ or ‘non-referral’ outcomes of patients identified. Aim To evaluate how the CKD trigger tool is used across practices in east London. To examine how the differences in the practitioner use and perceived value of the tool is characterised by interview transcripts, compared with the written reflections. Method Eight semi-structured interviews were undertaken with six GPs, one pharmacist, and one practice manager. The reflection free-text data were organised into categories, of ‘yes’ and ‘no’ referrals, dividing further each category by ‘young’ and ‘old’ cases. Thematic analysis was applied to the interview transcripts. Arising themes were supplemented by the descriptive analysis of the reflection. Results In total 1921 reflection comments were examined, 1770 ‘No’ referrals (935 aged <60 years) and 151 ‘Yes’ referrals (81 aged <60 years), covering a 2-year period. Four themes emerged from the interviews: ‘Getting started …’, ‘Workflow’, ‘Trigger tool as a learning tool’, and ‘Patient safety’. Conclusion The study highlights that administratively well organised practices found that the tool could be readily embedded into their workflow. Reflection data highlighted cases of poorly controlled diabetes and/or hypertension for the ‘yes–young’ referrals. Generally, ‘No’ referrals emphasised the implementation of a clinical management plan.
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