Better Kidney Disease Management with Remote Consultation
Evidence shows that CKD patients who live far from a nephrology practice are hospitalised more frequently and have a higher mortality rate than patients who live near one. For this retrospective study, Rajeev Rohatgi, MD, FASN, Mount Sinai Hospital (New York, NY), and colleagues analysed clinical outcomes of 121 CKD patients who lived near and enrolled at the Bronx Veterans Affairs Medical Center (VAMC) clinic. The data were compared with outcomes of 117 CKD patients who lived far from a VA nephrologist and enrolled in telenephrology sessions. These patients were evaluated remotely by a nephrologist located at the Bronx VAMC from 2008 to 2014.
The kidney disease characteristics — initial creatinine, eGFR, distribution of CKD stage, and urine protein — of the two groups were similar. However, data analysis revealed the frequency of attending appointments was greater in the telenephrology group (70.8 percent) versus the conventional care group (61.8 percent). This was due to a greater frequency of cancelled visits in the conventional care (27.9 percent) compared to the telenephrology group (15.8 percent). In addition, the study showed composite clinical outcomes — end stage renal disease, doubling of serum creatinine, and death — did not differ between the patient groups.
Dr. Rohatgi's team notes that prior to the establishment of a telenephrology service, more than 50 percent of patients who lived far from a VA nephrologist either cancelled or missed their scheduled appointments at the Bronx VAMC. The number was reduced by nearly half after telenephrology was instituted. The research team speculates that delivering care to CKD patients locally improves the likelihood that they will attend their scheduled visits and this, in turn, leads to clinical outcomes that are equal to conventional care.
“These data imply that remote delivery of care via telenephrology has the potential to deliver equitable, patient-centred care to a geographically diverse patient population,” Dr. Rohatgi explained, “while alleviating disparity in care.”
Source: American Society of Nephrology
Image credit: Flickr.com
Published on : Mon, 9 Nov 2015
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