Développement d'une clinique virtuelle pour les maladies rénales chroniques
Financement
Financement des capacités de recherche du CCG de Bristol, North Somerset et South Gloucestershire (développement local)
Quelle est la question de recherche ?
How can a virtual Chronic Kidney Disease (vCKD) clinic for Bristol be developed and formally evaluated, avoiding unintended harm at the patient or population level?
Quel est le problème ?
It is estimated that 4-9% of people in England have Chronic Kidney Disease (CKD) stages 3-5, currently equivalent to 1.9-3.6 million people, with a predicted increase to 4.2 million by 2036.
Early detection of CKD and appropriate management can prevent morbidity by reducing the risk of developing kidney failure and the risk of cardiovascular events. Reducing these risks could deliver significant cost savings to the NHS.
Some patients require input from a secondary care nephrologist. There is an urgent need for innovative change in the delivery of CKD outpatient services in order to meet increasing demands under tightening financial constraints.
Barts NHS Trust runs a virtual CKD clinic using the EMIS Electronic Patient Record (EPR) platform. They report successes, including reduced time for consultant review and reduced waiting time for face-to-face appointments.
The clinic model also uses primary care ‘trigger tools’ prompting referral to nephrology, which have the potential to reduce variation and inequity in access to nephrology care.
However, the Barts vCKD clinic was not formally evaluated and had some unexpected results: the workload of the nephrology department increased significantly, partly attributable to the provision of care to a population with significant deprivation and undiagnosed or untreated CKD.
Quel est l'objectif de la recherche ?
To develop and formally evaluate an evidence-based vCKD clinic for Bristol.
The results may be applicable to CKD populations and renal centres nationwide, and as such will influence other renal unit policies and national policy on outpatient delivery of renal services.
Comment cela sera-t-il réalisé ?
The need for a vCKD clinic will be established by auditing and analysing current referrals and unmet needs and by estimating the effects of a virtual clinic on the workforce and environment.
The vCKD clinic will be designed by investigating current vCKD clinics, establishing the limitations of infrastructure and by consulting key stakeholders such as patients, nephrologists, primary care practitioners, and commissioners.
Predictive tools to detect patients in need of CKD management advice will be investigated, and outcomes important to patients and clinicians will be identified.
The vCKD clinic will then be implemented and assessed by looking at clinical outcomes, logistical issues, efficiency and cost outcomes, patient-reported outcomes, and interviews with patients, primary care practitioners and nephrologists about their experiences.
Qui dirige la recherche ?
Dr Dominic Taylor, Consultant Nephrologist, Richard Bright Renal Service, North Bristol NHS Trust.
Informations complémentaires :
Pour plus d'informations ou pour participer à ce projet, veuillez envoyer un courriel. bnssg.research@nhs.net.