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

Abstract

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.