Attitudes of Canadian nephrologists toward multidisciplinary team-based CKD clinic care.
BACKGROUND
Although evidence supporting the advantages of multidisciplinary team-based chronic kidney disease (CKD) care is not well developed, many groups are advocating increased availability of this model.


METHODS
The research design is a mailed survey sent to 523 members of the Canadian and Quebec Societies of Nephrology.


RESULTS
After excluding 113 respondents who declared themselves to be ineligible, the response rate was 54%. Ninety-one percent of nephrologists reported that they usually or always use a CKD clinic. Decisions about when to perform CKD-related tasks were based mainly on an estimate of glomerular filtration rate, rather than time remaining before end-stage renal disease (ESRD). The ideal creatinine clearance for referral to a CKD clinic was 30 to 59 mL/min (0.50 to 0.98 mL/s), but the usual level was 20 to 29 mL/min (0.33 to 0.44 mL/s). The ideal time for referral was more than 12 months before ESRD. Renal replacement therapy discussions were initiated at a creatinine clearance of 20 to 29 mL/min (57%). Nephrologists supported promotion of home dialysis for suitable patients, but not mandating this. Nephrologists did not provide a blunt prognosis to patients who did not specifically ask. Late referral based on adequate time for ESRD preparation was reported to be 4 to 6 months (27%), 7 to 9 months (26%), or 10 to 12 months (30%). Thirty-eight percent said that optimal preparation takes 13 months or longer.


CONCLUSIONS
The literature's common definition of less than 3 months as a cutoff value between late and early referral is not endorsed. Given that multidisciplinary team-based care is widely available in Canada, this study might inform other jurisdictions about the merits and problems associated with multidisciplinary team-based care and might shape the agenda for future empirical research.
Mendelssohn
David C
DC
Department of Nephrology, Humber River Regional Hospital, University of Toronto, Weston, Canada. dmendelssohn@hrrh.on.ca
Toffelmire
Edwin B
EB
Levin
Adeera
A
D001291:Attitude of Health Personnel; D002170:Canada; D006268:Health Facilities; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D009398:Nephrology; D010348:Patient Care Team; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires