Web-based nephrology consults may reduce referrals

(HealthDay)—A system of Web-based consultations (telenephrology) may reduce the number of specialty referrals for patients with chronic kidney disease, according to a study published in the March/April issue of the Annals of Family Medicine.

Nynke D. Scherpbier-de Haan, M.D., from Radboud University Nijmegen Medical Centre in the Netherlands, and colleagues assessed telenephrology consultations for patients with chronic kidney disease performed by 28 family practices and five nephrology departments in the Netherlands from May 2009 to August 2011 in an observational, prospective study. The potential reduction of in-person referrals, which were measured as the difference between the number of intended referrals by the family physician and the number of referrals requested by the nephrologist, was the primary outcome. System usability, as assessed by the time invested, implementation in daily work hours, and response time, was also measured.

The researchers found that 35.3 percent of the 122 new consultations would have been referred by their family physicians, while the nephrologist deemed only 13.9 percent as needing referral (P < 0.001). The nephrologist deemed referrals necessary for 10 of the 79 patients that the family physician would have treated in primary care. Consultations were usually performed during office hours and necessitated a time investment of less than 10 minutes per consultation. The time to response was 1.6 days. Most questions related to estimated glomerular filtration rate, proteinuria, and blood pressure.

"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," write the authors.

One author reports financial ties to the pharmaceutical industry. The Radboud University Nijmegen Medical Centre received a grant from Amgen. TeleMC developed the telenephrology system.

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