title: Assessment of the quality of care and financial impact of a virtual renal clinic compared with the traditional outpatient service model.
abstract: BACKGROUND
  Patients with chronic kidney disease (CKD) have better outcomes when they have access to specialist nephrology services early in the course of their disease. However, up to 30% of patients with advanced kidney disease face late referral. Virtual clinics represent a potentially innovative mechanism for early assessment of high patient volumes efficiently and cost effectively while maintaining high standards of care.
  
  
  METHODS
  A retrospective observational cohort study was completed over a 4-year period from April 2004 to March 2008 at a regional nephrology centre within Northern Ireland. All new patient attendances at the nephrology clinic were identified and those managed via the virtual renal clinic approach were included in this study. A cost comparison of this innovative modality was made with the traditional outpatient service model.
  
  
  RESULTS
  There were 427 patients (51.3% female, 48.7% male) managed through the virtual renal clinic. Comorbidities included 180 patients (42.1%) with known CKD and 31 patients (7.3%) with newly identified kidney disease. A total of 118 patients (27.6%) had hypertension while 6 (1.4%) and 57 (13.3%) had type I and II diabetes mellitus (DM) respectively. Referral indications included 211 patients (49.4%) with abnormal renal biochemistry, 35 (8.2%) with proteinuria, 12 (2.8%) with haematuria and 87 patients (20.4%) with a combination of issues. A conservative treatment plan consisting of biochemical surveillance was appropriate for 246 patients (57.6%) while medication review was completed for 113 patients (26.5%) and surgical referral was indicated in 20 patients (4.7%). The virtual renal clinic provided a minimum cost saving of £111.56 per patient attendance compared with traditional outpatient care resulting in 23.3% of patient referrals being managed by the virtual clinic approach in 2009.
  
  
  CONCLUSIONS
  Delayed referral to a renal specialist adversely affects patient outcomes. This study suggests that the implementation of a virtual renal clinic for non-complex renal pathologies can offer a cost-effective, rapid referral mechanism for patient assessment combined with readily available specialist advice.
authors.affiliation: Department of General Surgery, Daisy Hill Hospital, 5 Hospital Road, Newry BT35 8DR, UK.
authors.forename: D A
authors.initials: DA
authors.lastname: Mark
authors.forename: G J
authors.initials: GJ
authors.lastname: Fitzmaurice
authors.forename: K A
authors.initials: KA
authors.lastname: Haughey
authors.forename: M E
authors.initials: ME
authors.lastname: O'Donnell
authors.forename: J C
authors.initials: JC
authors.lastname: Harty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000379:methods* / Q000592:standards; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000191:economics / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D011787:Quality of Health Care; D012017:Referral and Consultation; D019114:Remote Consultation / Q000191:economics / Q000379:methods* / Q000592:standards; D012189:Retrospective Studies; D014584:User-Computer Interface; D055815:Young Adult