• Open Access

Referral and management options for patients with chronic kidney disease: perspectives of patients, generalists and specialists

Authors

  • Charlotte Wilson BSc (Hon) MA (Econ) PGCE,

    1. School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, United Kingdom
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  • Stephen M. Campbell BA (Hons) MA (Econ) PhD,

    1. Institute of Population Health, Primary Care, University of Manchester, Manchester, United Kingdom
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  • Karen A. Luker BNurs PhD RGN RHV DN Cert,

    1. School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, United Kingdom
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  • Ann-Louise Caress BNurs PhD RGN RHV DN Cert

    Professor of Nursing, Corresponding author
    1. School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, United Kingdom
    • Correspondence

      Ann-Louise Caress, Professor of Nursing

      School of Nursing

      Midwifery and Social Work

      The University of Manchester and University Hospital of South Manchester NHS Foundation Trust

      Room 6.341

      Jean McFarlane Building

      Manchester, M13 9PL

      United Kingdom

      E-mail: ann.caress@manchester.ac.uk

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Abstract

Background

Chronic Kidney Disease (CKD) is increasing in prevalence and significance as a global public health issue. Appropriate management of CKD stages 3–4 in either generalist or specialist care is essential in order to slow disease progression. As various consulting options between services may be used, it is important to understand how patients and practitioners view these options.

Objective

To elicit patient and practitioner views and preferences on the acceptability and appropriateness of referral practices and consulting options for CKD stage 3–4.

Design

A mixed methods approach involving a semi-structured interview and structured rating exercise administered by telephone.

Setting & participants

Adult (18+) patients with CKD stage 3–4 were recruited via their General Practitioner (GP). Practitioners were recruited from both general and specialist services.

Results

Sixteen patients and twenty-two practitioners participated in the study between July and September, 2011. Both patients and practitioners preferred ‘GP with access to a specialist’ and least preferred ‘Specialist Review’. Computer review and telephone review were acceptable to participants under certain conditions. Practitioners favoured generalist management of patients with CKD 3. Specialists recommended active discharge of patients with stabilised stage 4 back to generalist care. Both generalists and specialists strongly supported sharing patients' medical records via electronic consultation systems.

Conclusion

Participants tended to prefer the current model of CKD management. Suggested improvements included; increasing the involvement of patients in referral and discharge decisions; improving the adequacy of information given to specialists on referral and encouraging further use of clinical guidelines in practice.

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