Change in appropriate referrals to nephrologists after the introduction of automatic reporting of the estimated glomerular filtration rate

Recognition of CKD After the Introduction of Automated Reporting of Estimated GFR in the Veterans Health Administration

“…Although overall (unadjusted) CKD recognition improved to 54% among patients with eGFR 10-29 ml/min per 1.73 m 2 , only 2% of all patients with CKD saw a nephrologist in the 12 months after VA laboratories implemented automated eGFR reporting. Our results contrast with notable increases in nephrology referrals that occurred after eGFR reporting in several vertically integrated health care settings in Canada (10,11,16), the United Kingdom (17), and Australia (12). Several factors may explain these differences.…”

Referral interventions from primary to specialist care: a systematic review of international evidence

“…Process changes were defined as smallscale changes to some aspect of the individual referral process that did not involve the movement of staff or relocation of clinics, the methods in which referrals were triaged at hospital, or financial arrangements for referral. Process change interventions included: designated appointment slots and fast-track clinics for primary care referrals (n = 6), [60][61][62][63][64][65] direct access to screening (n = 9), 66 to referral (individual contact between a specialist and GP) (n = 11), [75][76][77][78][79][80][81][82][83][84][85] electronic referral systems (n = 10), [86][87][88][89][90][91][92][93][94][95] decision support tools (n = 10), [96][97][98][99][100][101][102][103][104][105] and waiting list review or watchful waiting (n = 3). [106][107][108] The overall picture for interventions that aim to moderate referral outcomes by changing an element of the referral process is mixed.…”

The Uncertainty of the eGFR

“…Recent mandatory reporting of eGFR in Australia and Canada has led to increased appropriate referral of elderly, diabetic and female patients to specialist nephrologists but it has also led to increased numbers of inappropriate T. Badrick (&) Á P. Turner Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia e-mail: tbadrick@bond.edu.au referrals [7,8]. Most of the adults classified as being in stage 3 CKD in the Canadian study are older females whereas in the Australian study no gender difference was noted.…”

“…In the Canadian experience the proportion of appropriate to inappropriate referrals did not change whereas in the Australian study there was an increased percentage of inappropriate referrals, mainly non-diabetic patients with eGFRs [30 mL/min/1.73 m 2 . It was suggested that the reasons for the inappropriate referrals are lack of familiarity with eGFR, lack of resources to manage patients with mild chronic renal failure in primary care, patient demand to be referred to a specialist and different perspectives as to what constitutes an appropriate referral [7]. In the Australian cohort the referral patients (see Table 1 for referral guidelines) had a significantly lower eGFR (39.6 vs 46.4 mL/min/1.73 m 2 ) but not a significantly different serum creatinine (140 vs 130 lmol/L) compared with the pre mandatory reporting group.…”