title: Results of a coordination and shared clinical information programme between primary care and nephrology.
abstract: BACKGROUND
  The high prevalence of chronic kidney disease (CKD) in the general population has created a need to coordinate specialised nephrology care and primary care. Although several systems have been developed to coordinate this process, published results are scarce and contradictory.
  
  
  OBJECTIVE
  To present the results of the application of a coordinated programme between nephrology care and primary care through consultations and a system of shared clinical information to facilitate communication and improve the criteria for referring patients.
  
  
  METHODS
  Elaboration of a coordinated care programme by the primary care management team and the nephrology department, based on the SEN-SEMFYC consensus document and a protocol for the study and management of arterial hypertension (AHT). Explanation and implementation in primary health care units. A directory of specialists’ consultations was created, both in-person and via e-mail. A continuous training programme in kidney disease and arterial hypertension was implemented in the in-person consultation sessions. The programme was progressively implemented over a three-year period (2007-2010) in an area of 426,000 inhabitants with 230 general practitioners. Use of a clinical information system named Salut en Xarxa that allows access to clinical reports, diagnoses, prescriptions, test results and clinical progression.
  
  
  RESULTS
  Improved referral criteria between primary care and specialised nephrology service. Improved prioritisation of visits. Progressive increase in referrals denied by specialists (28.5% in 2009), accompanied by an explanatory report including suggestions for patient management. Decrease in first nephrology outpatient visits that have been referred from primary care (15% in 2009). Family doctors were generally satisfied with the improvement in communication and the continuous training programme. The main causes for denying referral requests were: patients >70 years with stage 3 CKD (44.15%); patients <70 years with stage 3a CKD (19.15%); albumin/creatinine ratio <500 mg/g (12.23%); non-secondary, non-refractory, essential AHT (11.17%). The general practitioners included in the programme showed great interest and no complaints were registered.
  
  
  CONCLUSIONS
  The consultations improve adequacy and prioritisation of nephrology visits, allow for better communication between different levels of the health system, and offer systematic training for general practitioners to improve the management of nephrology patients. This process allows for referring nephrology patients with the most complex profiles to nephrology outpatient clinics.
authors.affiliation: Nephrology Department, Parc Taulí Health and University Corporation, Barcelona, Spain. MGarcia@tauli.cat
authors.forename: Manuel
authors.initials: M
authors.lastname: García García
authors.forename: Mari Pau
authors.initials: MP
authors.lastname: Valenzuela Mújica
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Martínez Ocaña
authors.forename: María del Sol
authors.initials: Mdel S
authors.lastname: Otero López
authors.forename: Esther
authors.initials: E
authors.lastname: Ponz Clemente
authors.forename: Thaïs
authors.initials: T
authors.lastname: López Alba
authors.forename: Enrique
authors.initials: E
authors.lastname: Gálvez Hernández
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D019090:Case Management / Q000458:organization & administration*; D004181:Directories as Topic; D004502:Education, Medical, Continuing / Q000458:organization & administration; D034742:Electronic Mail; D058005:General Practitioners / Q000523:psychology; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006753:Hospital Records; D006785:Hospitals, University / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy; D033183:Interdisciplinary Communication; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D009398:Nephrology / Q000193:education / Q000458:organization & administration*; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010348:Patient Care Team; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data; D016079:Refusal to Treat; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology