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Colombo F, Maye H, Rutherford S, King A, Hammerbeck-Ward C, Whitfield GA, McBain C, Colaco R, Entwistle H, Wadeson A, Lloyd S, Freeman S, Pathmanaban ON. Surgery versus radiosurgery for vestibular schwannoma: Shared decision making in a multidisciplinary clinic. Neurooncol Adv 2023; 5:vdad089. [PMID: 37547267 PMCID: PMC10403749 DOI: 10.1093/noajnl/vdad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Background Our neurosurgical unit adopted a model of shared decision-making (SDM) based on multidisciplinary clinics for vestibular schwannoma (VS). A unique feature of this clinic is the interdisciplinary counseling process with a surgeon presenting the option of surgery, an oncologist radiosurgery or radiotherapy, and a specialist nurse advocating for the patient. Methods This is a retrospective cohort study. All new patients seen in the combined VS clinic and referred from the skull base multidisciplinary team (MDT) from beginning of June 2013 to end of January 2019 were included. Descriptive statistics and frequency analysis were carried out for the full cohort. Results Three hundred and fifty-four patients presenting with new or previously untreated VS were included in the analysis. In our cohort, roughly one-third of patients fall into each of the treatment strategies with slightly smaller numbers of patients undergoing surgery than watch, wait and rescan (WWR) ,and SRS (26.6% vs. 32.8% and 37.9%, respectively). Conclusion In our experience, the combined surgery/oncology/specialist nurse clinic streamlines the patient experience for those with a VS suitable for either microsurgical or SRS/radiotherapy treatment. Decision-making in this population of patients is complex and when presented with all treatment options patients do not necessarily choose the least invasive option as a treatment. The unique feature of our clinic is the multidisciplinary counseling process with a specialist nurse advocating and guiding the patient. Treatment options are likely to become more rather than less complex in future years making combined clinics more valuable than ever in the SDM process.
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Affiliation(s)
- Francesca Colombo
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Helen Maye
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Scott Rutherford
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Andrew King
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Charlotte Hammerbeck-Ward
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Gillian A Whitfield
- Department of Neuro-Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Catherine McBain
- Department of Neuro-Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Rovel Colaco
- Department of Neuro-Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Helen Entwistle
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Andrea Wadeson
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Simon Lloyd
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Simon Freeman
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Omar N Pathmanaban
- Geoffrey Jefferson Brain Research Centre, Manchester Centre for Clinical Neurosciences, Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine, and Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
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Multidisciplinary Approach to the Care of Children With Acute Recurrent Pancreatitis and Chronic Pancreatitis. Pancreas 2022; 51:256-260. [PMID: 35584383 DOI: 10.1097/mpa.0000000000002008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of this article is to provide guidance to centers and organizations on the personnel (both physician and nonphysician) needed to create and sustain an optimal team, along with potential alternatives, to provide care to children with acute recurrent pancreatitis and chronic pancreatitis. METHODS This document was developed in collaboration with the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Pancreas Committee and the National Pancreas Foundation (NPF) after several meetings. RESULTS This document highlights both physician and nonphysician personnel needed to provide multidisciplinary care to children with pancreatitis per the recommendation of the NASPGHAN Pancreas Committee members in year 2021 and added to the currently published NPF criteria. We summarize how the NPF criteria would fit with the recently published pediatric pancreatitis society articles from the NASPGHAN. CONCLUSIONS It is important to manage children with acute recurrent pancreatitis and chronic pancreatitis in a multidisciplinary setting. There is need to study the impact of these personnel on the outcomes of children with pancreatitis.
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Rosenberg AGW, Pater MRA, Pellikaan K, Davidse K, Kattentidt-Mouravieva AA, Kersseboom R, Bos-Roubos AG, van Eeghen A, Veen JMC, van der Meulen JJ, van Aalst-van Wieringen N, Hoekstra FME, van der Lely AJ, de Graaff LCG. What Every Internist-Endocrinologist Should Know about Rare Genetic Syndromes in Order to Prevent Needless Diagnostics, Missed Diagnoses and Medical Complications: Five Years of 'Internal Medicine for Rare Genetic Syndromes'. J Clin Med 2021; 10:jcm10225457. [PMID: 34830739 PMCID: PMC8622899 DOI: 10.3390/jcm10225457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 02/06/2023] Open
Abstract
Patients with complex rare genetic syndromes (CRGS) have combined medical problems affecting multiple organ systems. Pediatric multidisciplinary (MD) care has improved life expectancy, however, transfer to internal medicine is hindered by the lack of adequate MD care for adults. We have launched an MD outpatient clinic providing syndrome-specific care for adults with CRGS, which, to our knowledge, is the first one worldwide in the field of internal medicine. Between 2015 and 2020, we have treated 720 adults with over 60 syndromes. Eighty-nine percent of the syndromes were associated with endocrine problems. We describe case series of missed diagnoses and patients who had undergone extensive diagnostic testing for symptoms that could actually be explained by their syndrome. Based on our experiences and review of the literature, we provide an algorithm for the clinical approach of health problems in CRGS adults. We conclude that missed diagnoses and needless invasive tests seem common in CRGS adults. Due to the increased life expectancy, an increasing number of patients with CRGS will transfer to adult endocrinology. Internist-endocrinologists (in training) should be aware of their special needs and medical pitfalls of CRGS will help prevent the burden of unnecessary diagnostics and under- and overtreatment.
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Affiliation(s)
- Anna G. W. Rosenberg
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
| | - Minke R. A. Pater
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
| | - Karlijn Pellikaan
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
| | - Kirsten Davidse
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
| | | | - Rogier Kersseboom
- Stichting Zuidwester, 3241 LB Middelharnis, The Netherlands; (A.A.K.-M.); (R.K.)
| | - Anja G. Bos-Roubos
- Center of Excellence for Neuropsychiatry, Vincent van Gogh, 5803 DN Venray, The Netherlands;
| | - Agnies van Eeghen
- ‘s Heeren Loo, Care Group, 3818 LA Amersfoort, The Netherlands;
- Department of Pediatrics, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - José M. C. Veen
- ‘s Heeren Loo, Care Providing Agency, 6733 SC Wekerom, The Netherlands; (J.M.C.V.); (J.J.v.d.M.)
| | - Jiske J. van der Meulen
- ‘s Heeren Loo, Care Providing Agency, 6733 SC Wekerom, The Netherlands; (J.M.C.V.); (J.J.v.d.M.)
| | - Nina van Aalst-van Wieringen
- Department of Physical Therapy, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - Franciska M. E. Hoekstra
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
- Department of Internal Medicine, Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands
| | - Aart J. van der Lely
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
| | - Laura C. G. de Graaff
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- ENCORE—Dutch Center of Reference for Neurodevelopmental Disorders, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Turner Syndrome, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Disorders of Sex Development, 3015 GD Rotterdam, The Netherlands
- Correspondence:
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Darukhanavala A, Kremer T. Automatic referrals within a cystic fibrosis multidisciplinary clinic improve patient evaluation and management. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2021; 24:100259. [PMID: 34195009 PMCID: PMC8237349 DOI: 10.1016/j.jcte.2021.100259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/26/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022]
Abstract
AUTOMATIC REFERRALS WITHIN A CYSTIC FIBROSIS MULTIDISCIPLINARY CLINIC IMPROVE PATIENT EVALUATION AND MANAGEMENT. Background Cystic fibrosis (CF) affects multiple systems beyond the pulmonary system, including the gastrointestinal and endocrine systems. Many CF clinics focus on pulmonary effects, initiating referrals to other specialties only when a condition has been identified by the primary pulmonary team. Unfortunately, many extrapulmonary manifestations of cystic fibrosis may be overlooked. Thus, implementing a multidisciplinary clinic with automatic referrals to designated subspecialists may improve patient care. Methods This retrospective review of medical records examined the effects of integrating a pediatric endocrinologist into the University of Massachusetts Memorial Medical Center Pediatric CF Clinic in March 2017. In this new CF/Endocrinology clinic, all patients scheduled to see a pulmonologist were automatically referred to pediatric endocrinology. We compared rates of referrals to pediatric endocrinology, oral glucose tolerance tests (OGTTs), and bone density (DEXA) scans before (2013–2016) and after (2017–2020) implementation of this clinic. We also recorded endocrine disorders being evaluated and/or treated after implementation. Results The rate of referral to pediatric endocrinology increased from before (4%) to after (82%) (p < 0.0001) implementation of the CF/Endocrinology Clinic. OGTT and DEXA scan screening rates also increased from 7% to 65% (p < 0.0001) and from 6% to 63% (p = 0.0011), respectively. Before implementation, patients were evaluated by endocrinology primarily for CF-related diabetes. After implementation, the diversity of endocrine conditions under evaluation and/or management increased substantially; the most common were vitamin D insufficiency/deficiency (37.2% of clinic patients), glycemic dysregulation (36.8%), and poor weight gain/failure to thrive (17.5%). Conclusion Implementing a multidisciplinary CF clinic with automatic referrals to pediatric endocrinology improves patient care by promoting early detection and management of endocrine concerns that may have been overlooked and by increasing OGTT and DEXA screening rates.
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Affiliation(s)
- Amy Darukhanavala
- Department of Pediatric Endocrinology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Ted Kremer
- Department of Pediatric Pulmonology, University of Massachusetts Medical Center, Worcester, MA, USA
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Saqlain F, Shalhout SZ, Flaherty KT, Emerick KS, Miller DM. REDCap-Based Operational Tool to Guide Care Coordination in a Multidisciplinary Cutaneous Oncology Clinic. JCO Oncol Pract 2021; 17:527-533. [PMID: 33492980 DOI: 10.1200/op.20.00673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The multidisciplinary team is the primary means for delivery of complex cancer care in the United States. Considerable variability exists in how multidisciplinary teams operate across the landscape of oncology, including variation in represented specialties and specifics of the shared medical decision-making process. Here, we describe operations of a multidisciplinary clinic focused on the management of nonmelanoma skin cancer, formed as a joint effort between departments at the Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary. We describe deployment of a flexible Web-based operational tool created on the Research Electronic Data Capture platform to facilitate provider coordination and tracking and visualization of the patient census, offering a new perspective on optimization of the multidisciplinary workflow. To help promote further discussion, we have made the data dictionary for the operational tool and R code for the accompanying data visualization dashboard freely available online for download and customization.
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Affiliation(s)
| | - Sophia Z Shalhout
- Harvard Medical School, Boston, MA.,Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA.,Mass General Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Keith T Flaherty
- Harvard Medical School, Boston, MA.,Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA.,Mass General Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Kevin S Emerick
- Harvard Medical School, Boston, MA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.,Department of Otolaryngology, Harvard Medical School, Boston, MA
| | - David M Miller
- Harvard Medical School, Boston, MA.,Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA.,Mass General Cancer Center, Massachusetts General Hospital, Boston, MA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA
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6
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Thibadeau J, Walker WO, Castillo J, Dicianno BE, Routh JC, Smith KA, Ouyang L. Philosophy of care delivery for spina bifida. Disabil Health J 2020; 13:100883. [PMID: 31928964 PMCID: PMC7477785 DOI: 10.1016/j.dhjo.2019.100883] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 12/06/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023]
Abstract
The multidisciplinary model (MCM) is described as one that utilizes skills and experience from practitioners belonging to various disciplines, each treating patients from a specific clinical perspective.1 The Spina Bifida Association (SBA) supports and recommends that clinical care for people with Spina Bifida (SB) be provided in specialty clinics of which the MCM is an example; that care be coordinated; and that there be a plan for transitional care.2 This paper explores the challenges the MCM faces with a transitioning and aging population in a care system that calls for a positive patient experience, engaged health care professionals, desired outcomes, with consideration of cost.
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Affiliation(s)
- Judy Thibadeau
- Spina Bifida Association, 1600 Wilson Blvd., Suite 800, Arlington, VA, 22209, USA.
| | - William O Walker
- Chief, Division of Developmental Medicine, Seattle Children's Hospital, Robert A. Aldrich Professor, Department of Pediatrics, University of Washington School of Medicine, USA
| | - Jonathan Castillo
- Developmental-Behavioral Pediatrics, Texas Children's Hospital, Baylor College of Medicine, USA
| | - Brad E Dicianno
- University of Pittsburgh School of Medicine, Department of Physical Medicine and Rehabilitation, Pittsburgh, PA, USA; Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | | | - Kathryn A Smith
- USC University Center for Excellence in Developmental Disabilities, Spina Bifida Program, Children's Hospital Los Angeles, Clinical Pediatrics, Keck School of Medicine, University of Southern California, USA
| | - Lijing Ouyang
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, USA
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7
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Li KL, Fang CH, Ferastraoaru D, Akbar NA, Jerschow E, Abuzeid WM. Patient Satisfaction and Efficiency Benefits of a Novel Multidisciplinary Rhinology and Allergy Clinic. Ann Otol Rhinol Laryngol 2020; 129:699-706. [PMID: 32059621 DOI: 10.1177/0003489420905859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the sinonasal mucosa and with strong associations to other immune-mediated comorbidities. Patients often require referral to both an otolaryngologist and an allergist/immunologist. This study is the first in the literature to describe a multidisciplinary clinic that offers patient care by subspecialists in rhinology and in allergy/immunology. METHODS One hundred twenty-nine patients were seen in the Comprehensive Sinus and Allergy Clinic (CSAC) between January 2016 and June 2017 and 43 selected patients were seen in both the standalone allergy and rhinology clinics over the same time period. Patient satisfaction was retrospectively assessed using a modified Press-Ganey satisfaction survey. Time to evaluation and time to follow up appointment were compared between the CSAC and both the standalone rhinology and allergy/immunology clinics. RESULTS Patients seen in the CSAC reported high satisfaction with the amount of time spent with the physicians (98.3%), quality of medical care (9.3 ± 1.0), and most importantly, the convenience of seeing two physicians in one day (9.5 ± 1.2). Time from referral placement to clinic evaluation (P ≤ .02) and time to follow up appointment (P ≤ .002) was significantly shorter for the CSAC than for the standalone Rhinology or Allergy clinics. CONCLUSION Patients reported high satisfaction with the medical care provided and were also seen much faster in our multidisciplinary clinic as compared to standalone rhinology or allergy/immunology clinics. Overall, a multidisciplinary approach may be beneficial to patients presenting to tertiary referral centers with CRS and atopic conditions.
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Affiliation(s)
- Kevin L Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denisa Ferastraoaru
- Department of Allergy & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nadeem A Akbar
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elina Jerschow
- Department of Allergy & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Waleed M Abuzeid
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
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Recommendations for the Establishment of Disorders/Differences of Sex Development Interdisciplinary Care Clinics for Youth. J Pediatr Nurs 2017; 37:79-85. [PMID: 28888337 DOI: 10.1016/j.pedn.2017.08.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/14/2017] [Accepted: 08/31/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE Provide recommendations for the development of an interdisciplinary care (IDC) clinic for the treatment of youth with disorders/differences of sex development (DSD). DSD consist of a group of complex congenital medical disorders in which the development of chromosomal, gonadal, or anatomical sex is atypical. Youth with DSD require care from multiple specialized healthcare disciplines, including several medical specialties, surgery, nursing, and mental health. METHOD Recommendations are based on an interdisciplinary care clinic model that allows for a team of relevant professionals who share knowledge, ideas, and responsibility of care. The framework established in this article is based largely on experiences at an established DSD clinic, as well as observations of multiple clinics across the United States. RESULTS Preliminary outcome data on clinic adherence to treatment protocol under an IDC model are provided. CONCLUSIONS To meet the diverse healthcare needs of youth with DSD, comprehensive care clinics are recommended; however, few such clinics exist in the United States. Establishing new comprehensive DSD clinics can be challenging due to the highly unique treatment of DSD, but the current paper expands the literature available to guide clinic development in the United States.
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Isaac DM, Wu J, Mager DR, Turner JM. Managing the pediatric patient with celiac disease: a multidisciplinary approach. J Multidiscip Healthc 2016; 9:529-536. [PMID: 27785047 PMCID: PMC5067051 DOI: 10.2147/jmdh.s95323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Celiac disease (CD) is an autoimmune reaction to gluten, leading to intestinal inflammation, villous atrophy, and malabsorption. It is the most common autoimmune gastrointestinal disorder, with an increasing prevalence. A life-long gluten-free diet (GFD) is an effective treatment to alleviate symptoms, normalize autoantibodies, and heal the intestinal mucosa in patients with CD. Poorly controlled CD poses a significant concern for ongoing malabsorption, growth restriction, and the long-term concern of intestinal lymphoma. Achieving GFD compliance and long-term disease control poses a challenge, with adolescents at particular risk for high rates of noncompliance. Attention has turned toward innovative management strategies to improve adherence and achieve better disease control. One such strategy is the development of multidisciplinary clinic approach, and CD is a complex life-long disease state that would benefit from a multifaceted team approach as recognized by multiple national and international bodies, including the National Institutes of Health. Utilizing the combined efforts of the pediatric gastroenterologist, registered dietitian, registered nurse, and primary care provider (general practitioner or general pediatrician) in a CD multidisciplinary clinic model will be of benefit for patients and families in optimizing diagnosis, provision of GFD teaching, and long-term adherence to a GFD. This paper discusses the benefits and proposed structure for multidisciplinary care in improving management of CD.
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Affiliation(s)
- Daniela Migliarese Isaac
- Department of Pediatric Gastroenterology and Nutrition, Faculty of Medicine and Dentistry, University of Alberta
| | - Jessica Wu
- Alberta Health Services-Child Health Nutrition Services, Stollery Children's Hospital
| | - Diana R Mager
- Department of Agriculture, Food and Nutritional Science; Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Justine M Turner
- Department of Pediatric Gastroenterology and Nutrition, Faculty of Medicine and Dentistry, University of Alberta
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Tyler KH, Haverkos BM, Hastings J, Hu E, Philips R, Gru AA, Welliver MX, Mishra A, Wong HK, Porcu P. The Role of an Integrated Multidisciplinary Clinic in the Management of Patients with Cutaneous Lymphoma. Front Oncol 2015; 5:136. [PMID: 26137450 PMCID: PMC4470273 DOI: 10.3389/fonc.2015.00136] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 06/01/2015] [Indexed: 11/17/2022] Open
Abstract
The clinical benefit of a multidisciplinary clinic practice model has been well described in a variety of medical specialties and cancer types. It proves particularly valuable when an integrated team is needed to optimally manage patients with rare or complex neoplasms. However, the ideal implementation of an integrated multidisciplinary care program for translational research and education has not been well reported. Herein, we propose how a multimodality cutaneous lymphoma (CL) clinic model can optimally manage CL patients. We offer our perspective on this model as an efficient means for delivering patient care, a continuing education resource for referring physicians, a conduit for translational and clinical research, and an educational tool for medical students, house staff, and fellows.
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Affiliation(s)
- Kelly H Tyler
- Division of Dermatology, The Ohio State University , Columbus, OH , USA
| | | | - Justin Hastings
- Division of Dermatology, The Ohio State University , Columbus, OH , USA ; Cutaneous Lymphoma Program, The Ohio State University , Columbus, OH , USA
| | - Eileen Hu
- School of Medicine, The Ohio State University , Columbus, OH , USA
| | - Ramez Philips
- School of Medicine, The Ohio State University , Columbus, OH , USA
| | - Alejandro A Gru
- Division of Dermatology, The Ohio State University , Columbus, OH , USA ; Cutaneous Lymphoma Program, The Ohio State University , Columbus, OH , USA ; Department of Pathology, The Ohio State University , Columbus, OH , USA
| | - Meng Xu Welliver
- Department of Radiation Oncology, The Ohio State University , Columbus, OH , USA
| | - Anjali Mishra
- Division of Dermatology, The Ohio State University , Columbus, OH , USA ; Cutaneous Lymphoma Program, The Ohio State University , Columbus, OH , USA ; Comprehensive Cancer Center, The Ohio State University , Columbus, OH , USA
| | - Henry K Wong
- Division of Dermatology, The Ohio State University , Columbus, OH , USA ; Cutaneous Lymphoma Program, The Ohio State University , Columbus, OH , USA ; Comprehensive Cancer Center, The Ohio State University , Columbus, OH , USA
| | - Pierluigi Porcu
- Division of Hematology, The Ohio State University , Columbus, OH , USA ; Cutaneous Lymphoma Program, The Ohio State University , Columbus, OH , USA ; Comprehensive Cancer Center, The Ohio State University , Columbus, OH , USA
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Haley WE, Beckrich AL, Sayre J, McNeil R, Fumo P, Rao VM, Lerma EV. Improving care coordination between nephrology and primary care: a quality improvement initiative using the renal physicians association toolkit. Am J Kidney Dis 2014; 65:67-79. [PMID: 25183380 DOI: 10.1053/j.ajkd.2014.06.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 06/30/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Individuals at risk for chronic kidney disease (CKD), including those with diabetes mellitus and hypertension, are prevalent in primary care physician (PCP) practices. A major systemic barrier to mitigating risk of progression to kidney failure and to optimal care is failure of communication and coordination among PCPs and nephrologists. STUDY DESIGN Quality improvement. Longitudinal practice-level study of tool-based intervention in nephrology practices and their referring PCP practices. SETTING & PARTICIPANTS 9 PCP and 5 nephrology practices in Philadelphia and Chicago. QUALITY IMPROVEMENT PLAN Tools from Renal Physicians Association toolkit were modified and provided for use by PCPs and nephrologists to improve identification of CKD, communication, and comanagement. OUTCOMES CKD identification, referral to nephrologists, communication among PCPs and nephrologists, comanagement processes. MEASUREMENTS Pre- and postimplementation interviews, questionnaires, site visits, and monthly teleconferences were used to ascertain practice patterns, perceptions, and tool use. Interview transcripts were reviewed for themes using qualitative analysis based on grounded theory. Chart audits assessed CKD identification and referral (PCPs). RESULTS PCPs improved processes for CKD identification, referral to nephrologists, communication, and execution of comanagement plans. Documentation of glomerular filtration rate was increased significantly (P=0.01). Nephrologists improved referral and comanagement processes. PCP postintervention interviews documented increased awareness of risk factors, the need to track high-risk patients, and the importance of early referral. Final nephrologist interviews revealed heightened attention to communication and comanagement with PCPs and increased levels of satisfaction among all parties. LIMITATIONS Nephrology practices volunteered to participate and recruit their referring PCP practices. Audit tools were developed for quality improvement assessment, but were not designed to provide statistically significant estimates. CONCLUSIONS The use of specifically tailored tools led to enhanced awareness and identification of CKD among PCPs, increased communication between practices, and improvement in comanagement and cooperation between PCPs and nephrologists.
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Affiliation(s)
- William E Haley
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL.
| | | | | | - Rebecca McNeil
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Peter Fumo
- Delaware Valley Nephrology, Philadelphia, PA
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Wijeysundera HC, Trubiani G, Wang X, Mitsakakis N, Austin PC, Ko DT, Lee DS, Tu JV, Krahn M. A Population-Based Study to Evaluate the Effectiveness of Multidisciplinary Heart Failure Clinics and Identify Important Service Components. Circ Heart Fail 2013; 6:68-75. [DOI: 10.1161/circheartfailure.112.971051] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Harindra C. Wijeysundera
- From the Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Ontario, Canada (H.C.W., D.T.K., J.V.T.); Toronto Health Economics and Technology Assessment Collaborative, Ontario, Canada (H.C.W., G.T., N.M., M.K.); Department of Medicine (H.C.W., D.T.K., D.S.L., J.V.T., M.K.), Faculty of Pharmacy (M.K.), Institute for Clinical Evaluative Sciences (H.C.W., X.W., P.C.A., D.T.K., D.S.L., J.V.T., M.K.), and Institute for Health Policy Management and Evaluation (H.C.W., P.C.A
| | - Gina Trubiani
- From the Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Ontario, Canada (H.C.W., D.T.K., J.V.T.); Toronto Health Economics and Technology Assessment Collaborative, Ontario, Canada (H.C.W., G.T., N.M., M.K.); Department of Medicine (H.C.W., D.T.K., D.S.L., J.V.T., M.K.), Faculty of Pharmacy (M.K.), Institute for Clinical Evaluative Sciences (H.C.W., X.W., P.C.A., D.T.K., D.S.L., J.V.T., M.K.), and Institute for Health Policy Management and Evaluation (H.C.W., P.C.A
| | - Xuesong Wang
- From the Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Ontario, Canada (H.C.W., D.T.K., J.V.T.); Toronto Health Economics and Technology Assessment Collaborative, Ontario, Canada (H.C.W., G.T., N.M., M.K.); Department of Medicine (H.C.W., D.T.K., D.S.L., J.V.T., M.K.), Faculty of Pharmacy (M.K.), Institute for Clinical Evaluative Sciences (H.C.W., X.W., P.C.A., D.T.K., D.S.L., J.V.T., M.K.), and Institute for Health Policy Management and Evaluation (H.C.W., P.C.A
| | - Nicholas Mitsakakis
- From the Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Ontario, Canada (H.C.W., D.T.K., J.V.T.); Toronto Health Economics and Technology Assessment Collaborative, Ontario, Canada (H.C.W., G.T., N.M., M.K.); Department of Medicine (H.C.W., D.T.K., D.S.L., J.V.T., M.K.), Faculty of Pharmacy (M.K.), Institute for Clinical Evaluative Sciences (H.C.W., X.W., P.C.A., D.T.K., D.S.L., J.V.T., M.K.), and Institute for Health Policy Management and Evaluation (H.C.W., P.C.A
| | - Peter C. Austin
- From the Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Ontario, Canada (H.C.W., D.T.K., J.V.T.); Toronto Health Economics and Technology Assessment Collaborative, Ontario, Canada (H.C.W., G.T., N.M., M.K.); Department of Medicine (H.C.W., D.T.K., D.S.L., J.V.T., M.K.), Faculty of Pharmacy (M.K.), Institute for Clinical Evaluative Sciences (H.C.W., X.W., P.C.A., D.T.K., D.S.L., J.V.T., M.K.), and Institute for Health Policy Management and Evaluation (H.C.W., P.C.A
| | - Dennis T. Ko
- From the Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Ontario, Canada (H.C.W., D.T.K., J.V.T.); Toronto Health Economics and Technology Assessment Collaborative, Ontario, Canada (H.C.W., G.T., N.M., M.K.); Department of Medicine (H.C.W., D.T.K., D.S.L., J.V.T., M.K.), Faculty of Pharmacy (M.K.), Institute for Clinical Evaluative Sciences (H.C.W., X.W., P.C.A., D.T.K., D.S.L., J.V.T., M.K.), and Institute for Health Policy Management and Evaluation (H.C.W., P.C.A
| | - Douglas S. Lee
- From the Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Ontario, Canada (H.C.W., D.T.K., J.V.T.); Toronto Health Economics and Technology Assessment Collaborative, Ontario, Canada (H.C.W., G.T., N.M., M.K.); Department of Medicine (H.C.W., D.T.K., D.S.L., J.V.T., M.K.), Faculty of Pharmacy (M.K.), Institute for Clinical Evaluative Sciences (H.C.W., X.W., P.C.A., D.T.K., D.S.L., J.V.T., M.K.), and Institute for Health Policy Management and Evaluation (H.C.W., P.C.A
| | - Jack V. Tu
- From the Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Ontario, Canada (H.C.W., D.T.K., J.V.T.); Toronto Health Economics and Technology Assessment Collaborative, Ontario, Canada (H.C.W., G.T., N.M., M.K.); Department of Medicine (H.C.W., D.T.K., D.S.L., J.V.T., M.K.), Faculty of Pharmacy (M.K.), Institute for Clinical Evaluative Sciences (H.C.W., X.W., P.C.A., D.T.K., D.S.L., J.V.T., M.K.), and Institute for Health Policy Management and Evaluation (H.C.W., P.C.A
| | - Murray Krahn
- From the Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Ontario, Canada (H.C.W., D.T.K., J.V.T.); Toronto Health Economics and Technology Assessment Collaborative, Ontario, Canada (H.C.W., G.T., N.M., M.K.); Department of Medicine (H.C.W., D.T.K., D.S.L., J.V.T., M.K.), Faculty of Pharmacy (M.K.), Institute for Clinical Evaluative Sciences (H.C.W., X.W., P.C.A., D.T.K., D.S.L., J.V.T., M.K.), and Institute for Health Policy Management and Evaluation (H.C.W., P.C.A
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Wijeysundera HC, Trubiani G, Abrahamyan L, Mitsakakis N, Witteman W, Paulden M, van der Velde G, Kingsbury K, Krahn M. Specialized multi-disciplinary heart failure clinics in Ontario, Canada: an environmental scan. BMC Health Serv Res 2012; 12:236. [PMID: 22863276 PMCID: PMC3506498 DOI: 10.1186/1472-6963-12-236] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 07/31/2012] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Multi-disciplinary heart failure (HF) clinics have been shown to improve outcomes for HF patients in randomized clinical trials. However, it is unclear how widely available specialized HF clinics are in Ontario. Also, the service models of current clinics have not been described. It is therefore uncertain whether the efficacy of HF clinics in trials is generalizable to the HF clinics currently operating in the province. METHODS As part of a comprehensive evaluation of HF clinics in Ontario, we performed an environmental scan to identify all HF clinics operating in 2010. A semi-structured interview was conducted to understand the scope of practice. The intensity and complexity of care offered were quantified through the use of a validated instrument, and clinics were categorized as high, medium or low intensity clinics. RESULTS We identified 34 clinics with 143 HF physicians. We found substantial regional disparity in access to care across the province. The majority of HF physicians were cardiologists (81%), with 81% of the clinics physically based in hospitals, of which 26% were academic centers. There was a substantial range in the complexity of services offered, most notably in the intensity of education and medication management services offered. All the clinics focused on ambulatory care, with only one having an in-patient focus. None of the HF clinics had a home-based component to care. CONCLUSIONS Multiple HF clinics are currently operating in Ontario with a wide spectrum of care models. Further work is necessary to understand which components lead to improved patient outcomes.
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Affiliation(s)
- Harindra C Wijeysundera
- Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Gina Trubiani
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Ontario, Canada
| | - Lusine Abrahamyan
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Ontario, Canada
| | - Nicholas Mitsakakis
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Ontario, Canada
| | - William Witteman
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Ontario, Canada
| | - Mike Paulden
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Ontario, Canada
| | - Gabrielle van der Velde
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Ontario, Canada
- Institute for Work & Health, Ontario, Canada
| | | | - Murray Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
- University Health Network – Toronto General Hospital, Ontario, Canada
- Faculty of Pharmacy, University of Toronto, Ontario, Canada
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Campbell GA, Bolton WK. Referral and comanagement of the patient with CKD. Adv Chronic Kidney Dis 2011; 18:420-7. [PMID: 22098660 DOI: 10.1053/j.ackd.2011.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 10/18/2011] [Accepted: 10/21/2011] [Indexed: 11/11/2022]
Abstract
CKD is a common condition with well-documented associated morbidity and mortality. Given the substantial disease burden of CKD and the cost of ESRD, interventions to delay progression and decrease comorbidity remain an important part of CKD care. Early referral to nephrologists has been shown to delay progression of CKD. Conversely, late referral has been associated with increased hospitalizations, higher mortality, and worsened secondary outcomes. Late referral to nephrology has been consequent to numerous factors, including the health care system, provider issues, and patient related factors. In addition to timely referral to nephrologists, the optimal modality to provide care for CKD patients has also been evaluated. Multidisciplinary clinics have shown significant improvements in other disease states. Data for the use of these clinics have shown benefit in mortality, progression, and laboratory markers of disease severity. However, studies supporting the use of multidisciplinary clinics in CKD have been mixed. Evidence-based guidelines from groups, including Renal Physicians Association and NKF, provide tools for management of CKD patients by both generalists and nephrologists. Through the use of guidelines, timely referral, and a multidisciplinary approach to care, the ability to provide effective and efficient care for CKD patients can be improved. We present a model to guide a multidisciplinary comanagement approach to providing care to patients with CKD.
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Germain MJ, Kurella Tamura M, Davison SN. Palliative care in CKD: the earlier the better. Am J Kidney Dis 2010; 57:378-80. [PMID: 21168946 DOI: 10.1053/j.ajkd.2010.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 12/02/2010] [Indexed: 12/25/2022]
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Wijeysundera HC, Machado M, Wang X, Van Der Velde G, Sikich N, Witteman W, Tu JV, Lee DS, Goodman SG, Petrella R, O'Flaherty M, Capewell S, Krahn M. Cost-effectiveness of specialized multidisciplinary heart failure clinics in Ontario, Canada. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2010; 13:915-921. [PMID: 21091970 DOI: 10.1111/j.1524-4733.2010.00797.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Specialized multidisciplinary clinics have been shown to reduce mortality in heart failure (HF). Our objective was to evaluate the cost-effectiveness of this model of care delivery. METHODS We performed a cost-effectiveness analysis, with a 12-year time horizon, from the perspective of the Ontario Ministry of Health and Long-term Care, comparing a standard care cohort, consisting of all patients admitted to hospital with HF in 2005, to a hypothetical cohort treated in HF clinics. Survival curves describing the natural history of HF were constructed using mortality estimates from the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study. Survival benefits and resource uptake associated with HF clinics were estimated from a meta-analysis of published trials. HF clinics costs were obtained by costing a representative clinic in Ontario. Health-related costs were determined through linkage to administrative databases. Outcome measures included life expectancy (years), costs (in 2008 Canadian dollars) and the incremental cost-effectiveness ratio (ICER). RESULTS HF clinics were associated with a 29% reduction in all-cause mortality (risk ratio [RR] 0.71; 95% confidence interval [CI] 0.56-0.91) but a 12% increase in hospitalizations (RR 1.12; 95% CI 0.92-1.135). The cost of care in HF clinics was $52 per 30 patient-days. Projected life-expectancy of HF clinic patients was 3.91 years, compared to 3.21 years for standard care. The 12-year cumulative cost per patient in the HF clinic group was $66,532 versus $53,638 in the standard care group. The ICER was $18,259/life-year gained. CONCLUSIONS HF clinics appear to be a cost effective way of delivering ambulatory care to HF patients.
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Affiliation(s)
- Harindra C Wijeysundera
- Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Rocco MV. Disease Management Programs for CKD Patients: The Potential and Pitfalls. Am J Kidney Dis 2009; 53:S56-63. [DOI: 10.1053/j.ajkd.2008.07.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 07/31/2008] [Indexed: 11/11/2022]
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Chow KM, Szeto CC, Law MC, Kwan BCH, Leung CB, Li PKT. Impact of Early Nephrology Referral on Mortality and Hospitalization in Peritoneal Dialysis Patients. Perit Dial Int 2008. [DOI: 10.1177/089686080802800411] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives Several studies have examined the possible association between late referral to a nephrologist and mortality on maintenance hemodialysis. However, we lack information on the benefit of early nephrologist referral in patients receiving peritoneal dialysis (PD). Patients and Methods In an inception cohort of 102 consecutive PD patients identified in a single center between 2003 and 2004, we sought to determine whether late nephrologist referral was associated with poor outcomes. The primary end point was all-cause mortality. The effects of early referral to a multidisciplinary low clearance clinic on cardiovascular mortality and length of hospitalization were also evaluated. Results Of 102 incident PD patients, 61 subjects (59.8%) were referred early to the nephrologist (more than 3 months) before dialysis initiation. During the study period of 284.9 patient-years (median follow-up period 36.8 months), 25 patients died, 12 due to cardiovascular causes. Both cardiovascular and all-cause mortality were significantly increased among PD patients with late referral, but the relationship between late referral and all-cause mortality was mitigated substantially by adjusting for relevant factors. In univariate analysis, late nephrology referral was associated with increased cardiovascular mortality, with a hazard ratio of 5.43 (95% confidence interval 1.46 – 20.21, p = 0.012). Annual adjusted days of hospitalization were similar between the early and late nephrology referral groups. Conclusions A comprehensive analysis of incident PD subjects confirmed the significant relationship between late nephrology referral and all-cause and cardiovascular mortality. A causal relationship remains to be established and validated.
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Affiliation(s)
- Kai Ming Chow
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Cheuk Chun Szeto
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Man Ching Law
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Bonnie Ching-Ha Kwan
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Chi Bon Leung
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Philip Kam-Tao Li
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
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Blantz RC. Handing Out Grades for Care in Chronic Kidney Disease: Nephrologists versus Non-Nephrologists. Clin J Am Soc Nephrol 2007; 2:193-5. [PMID: 17699404 DOI: 10.2215/cjn.00100107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sprangers B, Evenepoel P, Vanrenterghem Y. Late referral of patients with chronic kidney disease: no time to waste. Mayo Clin Proc 2006; 81:1487-94. [PMID: 17120405 DOI: 10.4065/81.11.1487] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The prevalence of patients with chronic kidney disease (CKD) in the US population is approximately 11%, and because of the increase in life expectancy and in diabetic nephropathy incidence, an exponential increase is predicted for the next decades. During the past decade, evidence that the progression of CKD can be attenuated by a multifactorial therapeutic approach has been increasing. However, a substantial percentage of patients with CKD will have progression to CKD stage V (ie, need for renal replacement therapy). Late referral of these patients (ie, <1 to 6 months before the start of renal replacement therapy) has been shown to be associated with higher mortality, morbidity, and costs. However, up to 64% of patients with CKD are still referred late. This review presents the available data on the epidemiology, causes, and consequences of late patient referral. Furthermore, it offers information to prevent late referral, improve CKD patient care, and change clinical practice.
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Affiliation(s)
- Ben Sprangers
- Department of Nephrology, University Hospital Gasthuisberg, Leuven, Belgium
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