Stoves John, Connolly John, Cheung Chee Kay, Grange Angela, Rhodes Penny, O'Donoghue Donal, Wright John
Department of Renal Medicine, Bradford St Luke's Hospital, Little Horton Lane, Bradford BD5 0NA, UK.
Qual Saf Health Care. 2010 Oct;19(5):e54. doi: 10.1136/qshc.2009.038984. Epub 2010 Jun 16.
Chronic kidney disease is increasingly recognised in the UK, leading to a greater demand for specialist services. Traditional means of meeting this demand rely on GP referral of patients to see a nephrologist. Hospital assessment may be inconvenient for patients and inefficient for health services.
17 general practices and a secondary care nephrology service in Bradford, UK.
A before and after evaluation comparing nephrology referrals from implementation and non-implementation practices following the introduction of electronic consultations (e-consultations) for chronic kidney disease.
The number, appropriateness and quality of new referrals (paper and electronic) from primary care, the timeliness of responses and the satisfaction of patients and health professionals with the new service. Strategies for change Electronic sharing of primary care electronic health records with the nephrology service was introduced to implementation practices. Participating GPs attended education workshops and received paper and e-guidance about the new service.
There was a significant reduction in paper referrals from implementation practices. E-consultation provided nephrologists with access to more clinical information. GPs reported that the service was convenient, provided timely and helpful advice, and avoided outpatient referrals. Specialist recommendations were well followed, and GPs felt more confident about managing chronic kidney disease in the community.
E-consultation promotes effective management of patients with mild-to-moderate chronic kidney disease in primary care, allowing specialist resources to be directed towards supporting patients with more complex needs. There is a potential role for e-consultation in other chronic disease specialties.
慢性肾病在英国越来越受到关注，这导致对专科服务的需求不断增加。满足这一需求的传统方式依赖于全科医生（GP）将患者转诊至肾病科医生处。医院评估对患者来说可能不方便，对医疗服务来说效率也不高。
英国布拉德福德的17家全科诊所和一家二级医疗肾病服务机构。
一项前后评估，比较在引入慢性肾病电子咨询（e-咨询）后，实施和未实施该措施的诊所的肾病转诊情况。
初级医疗中新转诊（纸质和电子）的数量、合理性和质量、回复的及时性以及患者和医疗专业人员对新服务的满意度。变革策略：向实施诊所引入初级医疗电子健康记录与肾病服务的电子共享。参与的全科医生参加了教育研讨会，并收到了关于新服务的纸质和电子指南。
实施诊所的纸质转诊显著减少。电子咨询为肾病科医生提供了更多临床信息。全科医生报告称，该服务方便，能提供及时且有用的建议，并避免了门诊转诊。专科建议得到了很好的遵循，全科医生对在社区管理慢性肾病更有信心。
电子咨询促进了初级医疗中轻至中度慢性肾病患者的有效管理，使专科资源能够用于支持有更复杂需求的患者。电子咨询在其他慢性病专科可能也有潜在作用。
