基于网络的慢性肾脏病患者咨询流程的初步实施。
Initial implementation of a web-based consultation process for patients with chronic kidney disease.
机构信息
Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
出版信息
Ann Fam Med. 2013 Mar-Apr;11(2):151-6. doi: 10.1370/afm.1494.
PURPOSE
A Web-based consultation system (telenephrology) enables family physicians to consult a nephrologist about a patient with chronic kidney disease. Relevant data are exported from the patient's electronic file to a protected digital environment from which advice can be formulated by the nephrologist. The primary purpose of this study was to assess the potential of telenephrology to reduce in-person referrals.
METHODS
In an observational, prospective study, we analyzed telenephrology consultations by 28 family practices and 5 nephrology departments in the Netherlands between May 2009 and August 2011. The primary outcome was the potential reduction of in-person referrals, measured as the difference between the number of intended referrals as stated by the family physician and the number of referrals requested by the nephrologist. The secondary outcome was the usability of the system, expressed as time invested, the implementation in daily work hours, and the response time. Furthermore, we evaluated the questions asked.
RESULTS
One hundred twenty-two new consultations were included in the study. In the absence of telenephrology, 43 patients (35.3%) would have been referred by their family physicians, whereas the nephrologist considered referral necessary in only 17 patients (13.9%) (P <.001). The family physician would have treated 79 patients in primary care. The nephrologist deemed referral necessary for 10 of these patients. Time investment per consultation amounted to less than 10 minutes. Consultations were mainly performed during office hours. Response time was 1.6 days (95% CI, 1.2-1.9 days). Most questions concerned estimated glomerular filtration rate, proteinuria, and blood pressure.
CONCLUSION
A Web-based consultation system might reduce the number of referrals and is usable. Telenephrology may contribute to an effective use of health facilities by allowing patients to be treated in primary care with remote support by a nephrologist.
目的
基于网络的咨询系统（远程肾病学）使家庭医生能够就慢性肾脏病患者咨询肾病学家。将相关数据从患者的电子病历中导出到受保护的数字环境，肾病学家可以在该环境中提供建议。本研究的主要目的是评估远程肾病学减少当面转诊的潜力。
方法
在一项观察性、前瞻性研究中，我们分析了 2009 年 5 月至 2011 年 8 月期间荷兰的 28 家家庭诊所和 5 家肾病科的远程肾病学咨询。主要结局是减少当面转诊的可能性，以家庭医生所陈述的转诊意向数量与肾病学家要求的转诊数量之间的差异来衡量。次要结局是该系统的可用性，表现为投入的时间、在日常工作时间中的实施情况以及响应时间。此外，我们还评估了所提出的问题。
结果
本研究共纳入 122 例新咨询病例。如果没有远程肾病学，43 名患者（35.3%）将被家庭医生转诊，而肾病学家认为仅 17 名患者（13.9%）需要转诊（P<0.001）。家庭医生将在初级保健中治疗 79 名患者。肾病学家认为这 10 名患者需要转诊。每次咨询的时间投入不到 10 分钟。咨询主要在办公时间进行。响应时间为 1.6 天（95%置信区间，1.2-1.9 天）。大多数问题涉及估计肾小球滤过率、蛋白尿和血压。
结论
基于网络的咨询系统可能会减少转诊数量，且具有实用性。远程肾病学可以通过允许患者在初级保健中接受远程支持由肾病学家进行治疗，从而有助于有效利用卫生设施。
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