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Timely Referral and Co-Management of CKD Patients

Timely Referral and Co-Management of CKD Patients. Christopher Keller, MD Director of Clinical Operations Boise Kidney and Hypertension Institute RPA 2011 Annual Meeting Friday, March 18, 2011. Disclosure of Conflict of Interest. Timely Referral and Co-Management of CKD Patients.

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Timely Referral and Co-Management of CKD Patients

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  1. Timely Referral and Co-Management of CKD Patients Christopher Keller, MD Director of Clinical Operations Boise Kidney and Hypertension Institute RPA 2011 Annual Meeting Friday, March 18, 2011

  2. Disclosure of Conflict of Interest

  3. Timely Referral and Co-Management of CKD Patients Christopher Keller, MD Director of Clinical Operations Boise Kidney and Hypertension Institute RPA 2011 Annual Meeting Friday, March 18, 2011

  4. Complexity Anemia/ Bone Dialysis

  5. What are the issues? • Primary care providers (PCPs) often defer referrals until very advanced stages of CKD • 25-50% of all ESRD patients never saw a nephrologist until 3 months or less before onset of dialysis • Reasons for not referring: advanced age, comorbidities, and perceived patient nonadherence to therapy Fischer MJ et al., Am J Nephrol 2011;33:60-69 Navaneethan et al., Clin Nephrol 2010;73:260-267

  6. What are the issues? • Nephrologists are spending more time focused on CKD progression and less time on non-nephrology concerns • The use of a multidisciplinary team (MDT) to manage stage 3-4 CKD patients may slow progression of CKD and may improve outcomes at the start of dialysis Diamantidis CJ et al., Clin J Am Soc Nephrol 2011;6:334-343 Bayliss EA et al., Clin J Am Soc Nephrol 2011;6: April Epub

  7. Slowing CKD progression with an MDT Bayliss EA et al., Clin J Am Soc Nephrol 2011;6: April Epub

  8. Mortality benefit with an MDT Kaplan-Meyer survival after starting dialysis therapy Curtis et al. Nephrol Dial Transplant 2005;20:147

  9. Open the black box… • PCPs must play a critical role in the multidisciplinary team • RPA ToolKit website: http://www.renalmd.org/toolkit-form/ Diamantidis CJ et al., Clin J Am Soc Nephrol 2011;6:334-343

  10. How do we involve primary providers? • Step 1: Identify your goals for co-management • Preferences for timing of referrals • Step 2: Open communication lines with primary providers • Ask them directly about their co-management interests • Let them know that you are willing to answer questions Tonelli M et al., Ann Intern Med 2011;154:12-21

  11. How do we involve primary providers? • Step 3: Communicate regularly with primary providers • Ensure timely, effective communication with the PCPs every visit • Track referrals and identify providers that do not refer early; devote resources for education • Electronic record systems and note templates make it easier

  12. Boise Kidney model: Documentation

  13. Conclusions • The complexity and breath of nephrology management has been a barrier to PCP communication • Multidisciplinary care of advanced CKD patients may slow CKD progression and reduce mortality in CKD patients • Communication with PCPs is required to: • Optimize early referrals • Permit nephrologists more time and energy to focus on prevention of ESRD

  14. Any Questions?

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