Background: Consultation of a nephrologist is important in aligning care for patients with chronic kidney disease (CKD) at the primary-secondary care interface. However, current consultation methods come with practical difficulties that can lead to postponed consultation or patient referral instead. Objective: This study aimed to investigate whether a web-based consultation platform, telenephrology, led to a lower referral rate of indicated patients. Furthermore, we assessed consultation rate, quality of care, costs and general practitioner (GPs') experiences with telenephrology. Methods: Cluster randomized controlled trial with 47 general practices in the Netherlands was randomized to access to telenephrology or to enhanced usual care. A total of 3004 CKD patients aged 18 years or older who were under primary care were included (intervention group n = 1277, control group n = 1727) and 2693 completed the trial. All practices participated in a CKD management course and were given an overview of their CKD patients. Results: The referral rates amounted to 2.3% (n = 29) in the intervention group and 3.0% (n = 52) in the control group, which was a non-significant difference, OR 0.61; 95% CI 0.31 to 1.23. The intervention group's consultation rate was 6.3% (n = 81) against 5.0% (n = 87) (OR 2.00; 95% CI 0.75-5.33). We found no difference in quality of care or costs. The majority of GPs had a positive opinion about telenephrology. Conclusion: The data in our study do not allow for conclusions on the effect of telenephrology on the rate of patient referrals and provider-to-provider consultations, compared to conventional methods. It was positively evaluated by GPs and was non-inferior in terms of quality of care and costs.
RCT Entities:
Background: Consultation of a nephrologist is important in aligning care for patients with chronic kidney disease (CKD) at the primary-secondary care interface. However, current consultation methods come with practical difficulties that can lead to postponed consultation or patient referral instead. Objective: This study aimed to investigate whether a web-based consultation platform, telenephrology, led to a lower referral rate of indicated patients. Furthermore, we assessed consultation rate, quality of care, costs and general practitioner (GPs') experiences with telenephrology. Methods: Cluster randomized controlled trial with 47 general practices in the Netherlands was randomized to access to telenephrology or to enhanced usual care. A total of 3004 CKDpatients aged 18 years or older who were under primary care were included (intervention group n = 1277, control group n = 1727) and 2693 completed the trial. All practices participated in a CKD management course and were given an overview of their CKDpatients. Results: The referral rates amounted to 2.3% (n = 29) in the intervention group and 3.0% (n = 52) in the control group, which was a non-significant difference, OR 0.61; 95% CI 0.31 to 1.23. The intervention group's consultation rate was 6.3% (n = 81) against 5.0% (n = 87) (OR 2.00; 95% CI 0.75-5.33). We found no difference in quality of care or costs. The majority of GPs had a positive opinion about telenephrology. Conclusion: The data in our study do not allow for conclusions on the effect of telenephrology on the rate of patient referrals and provider-to-provider consultations, compared to conventional methods. It was positively evaluated by GPs and was non-inferior in terms of quality of care and costs.
Authors: Carola van Dipten; Davy Gerda Hermina Antoin van Dam; Wilhelmus Joannes Carolus de Grauw; Marcus Antonius Gerard Jan Ten Dam; Marcus Matheus Hendrik Hermans; Willem Jan Jozef Assendelft; Nynke Dorothea Scherpbier-de Haan; Jacobus Franciscus Maria Wetzels Journal: BMC Nephrol Date: 2021-05-19 Impact factor: 2.388
Authors: Carola van Dipten; Saskia van Berkel; Wim J C de Grauw; Nynke D Scherpbier-de Haan; Bouke Brongers; Karel van Spaendonck; Jack F M Wetzels; Willem J J Assendelft; Marianne K Dees Journal: BMC Fam Pract Date: 2018-06-06 Impact factor: 2.497
Authors: Mohamed A Osman; Kara Schick-Makaroff; Stephanie Thompson; Liza Bialy; Robin Featherstone; Julia Kurzawa; Deenaz Zaidi; Ikechi Okpechi; Syed Habib; Soroush Shojai; Kailash Jindal; Branko Braam; Erin Keely; Clare Liddy; Braden Manns; Marcello Tonelli; Brenda Hemmelgarn; Scott Klarenbach; Aminu K Bello Journal: BMJ Glob Health Date: 2019-09-13
Authors: Daniela C Gonçalves-Bradley; Ana Rita J Maria; Ignacio Ricci-Cabello; Gemma Villanueva; Marita S Fønhus; Claire Glenton; Simon Lewin; Nicholas Henschke; Brian S Buckley; Garrett L Mehl; Tigest Tamrat; Sasha Shepperd Journal: Cochrane Database Syst Rev Date: 2020-08-18