Continuum of therapy in progressive renal diseases (from predialysis to transplantation): analysis of a new organizational model.
In the aging of Western populations, decreased mortality is counterbalanced by an increase in morbidity, particularly involving chronic diseases such as most renal diseases. The price of the successful care of chronic conditions, such as cardiovascular diseases or diabetes, is a continuous increase in new dialysis patients. However, the increased survival of patients on chronic renal replacement therapies poses new challenges to nephrologists and calls for new models of care. Since its split from internal medicine, nephrology has seen a progressive trend toward super specialization and the differentiation into at least 3 major branches (nephrology, dialysis, and transplantation), following a path common to several other fields of internal medicine. The success in the care of chronic patients is owed not only to a careful technical prescription, but also to the ability to teach self-care and attain compliance; this requires good medical practice and a sound patient-physician relationship. In this context, the usual models of care may fail to provide adequate coordination and, despite valuable single elements, could end up as an orchestra without a conductor. We propose an integrated model of care oriented to the type of patient (tested in our area especially for diabetic patients): the patient is followed-up by the same team from the first signs of renal disease to eventual dialysis or transplantation. This model offers an interesting alternative both for patients, who usually seek continuity of care, and for nephrologists who prefer a holistic and integrated patient-physician approach.
Piccoli
Giuseppe
G
Department of Nehrology, University of Turin, Torino, Italy. gbpiccoli@hotmail.com
Piccoli
Giorgina Barbara
GB
Mezza
Elisabetta
E
Burdese
Manuel
M
Rosetti
Maura
M
Guarena
Cesare
C
Messina
Maria
M
Pacitti
Alfonso
A
Thea
Alessandra
A
Malfi
Bernardo
B
Soragna
Giorgio
G
Gai
Massimo
M
Mangiarotti
Giovanni
G
Jeantet
Alberto
A
Segoloni
Giuseppe Paolo
GP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D002908:Chronic Disease; D003266:Continuity of Patient Care / Q000458:organization & administration*; D018450:Disease Progression; D005260:Female; D006436:Hemodialysis Units, Hospital; D006437:Hemodialysis, Home; D006694:Holistic Health; D006785:Hospitals, University; D006801:Humans; D007558:Italy; D007674:Kidney Diseases / Q000473:pathology / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009398:Nephrology / Q000193:education / Q000458:organization & administration; D010349:Patient Compliance; D010817:Physician-Patient Relations; D011383:Progressive Patient Care / Q000458:organization & administration*; D006435:Renal Dialysis