title: Active collaboration with primary care providers increases specialist referral in chronic renal disease.
abstract: BACKGROUND
  Late referral to specialist nephrological care is associated with increased morbidity, mortality, and cost. Consequently, nephrologists' associations recommend early referral. The recommendations' effectiveness remains questionable: 22-51% of referrals need renal replacement therapy (RRT) within 3-4 months. This may be due to these recommendations addressing the specialist, rather than the primary care providers (PCP). The potential of specialist intervention aiming at slowing progression of chronic renal failure was introduced individually to some 250 local PCPs, and referral strategies were discussed. To overcome the PCPs' most often expressed fears, every referred patient was asked to report back to his PCP immediately after the initial specialist examination, and new medications were prescribed directly, and thus allotted to the nephrologist's budget.
  
  
  METHODS
  In retrospective analysis, the stage of renal disease in patients referred within three months before the introductory round (group A, n = 18), was compared to referrals two years later (group B, n = 50).
  
  
  RESULTS
  Relative number of patients remained stable (28%) for mild/ moderate chronic kidney disease (MMCKD), while there was a noticeable shift from patients referred severe chronic kidney disease (SCKD) (group A: 44%, group B: 20%) to patients referred in moderate chronic kidney disease (MCKD) (group A: 28%, group B: 52%).
  
  
  CONCLUSIONS
  Individually addressing PCPs' ignorance and concerns noticeably decreased late referral. This stresses the importance of enhancing the PCPs' problem awareness and knowledge of available resources in order to ensure timely specialist referral.
authors.affiliation: Bioinformatics Institute, Singapore, Republic of Singapore. mondry@hotmail.com
authors.forename: Adrian
authors.initials: A
authors.lastname: Mondry
authors.forename: Ai-Ling
authors.initials: AL
authors.lastname: Zhu
authors.forename: Marie
authors.initials: M
authors.lastname: Loh
authors.forename: Thuy D
authors.initials: TD
authors.lastname: Vo
authors.forename: Kai
authors.initials: K
authors.lastname: Hahn
mesh_terms: D000328:Adult; D000368:Aged; D019058:Community Networks / Q000458:organization & administration*; D005260:Female; D005858:Germany; D005919:Glomerular Filtration Rate; D006801:Humans; D007400:Interprofessional Relations; D007674:Kidney Diseases / Q000145:classification* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000706:statistics & numerical data; D010565:Persuasive Communication; D010818:Practice Patterns, Physicians' / Q000458:organization & administration / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors