Development of a virtual Chronic Kidney Disease clinic
Funding
BNSSCG CCG Research Capability Funding (Local development)
What is the research question?
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?
What is the problem?
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 run a virtual CKD clinic using the EMIS Electronic Patient Record (EPR) platform. They report successes, including reduced time to 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 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.
What is the aim of the research?
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 policy as well as national policy on outpatient delivery of renal services.
How will this be achieved?
The need for a vCKD clinic will be established by auditing and analysing current referrals and unmet need, 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 then 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.
Who is leading the research?
Dr Dominic Taylor, Consultant Nephrologist, Richard Bright Renal Service, North Bristol NHS Trust.
Further information:
For more information or to get involved in this project, please contact bnssg.research@nhs.net.