title: Canadian chronic kidney disease clinics: a national survey of structure, function and models of care.
abstract: BACKGROUND
  The goals of care for patients with chronic kidney disease (CKD) are to delay progression to end stage renal disease, reduce complications, and to ensure timely transition to dialysis or transplantation, while optimizing independence. Recent guidelines recommend that multidisciplinary team based care should be available to patients with CKD. While most provinces fund CKD care, the specific models by which these outcomes are achieved are not known. Funding for clinics is hospital or program based.
  
  
  OBJECTIVE
  To describe the structure and function of clinics in order to understand the current models of care, inform best practice and potentially standardize models of care.
  
  
  METHODS
  Prospective cross sectional observational survey study.
  Canadian nephrology programs in all provinces.
  
  
  METHODS
  Using an open-ended semi-structured questionnaire, we surveyed 71 of 84 multidisciplinary adult CKD clinics across Canada, by telephone and with written semi-structured questionnaires; (June 2012 to November 2013). Standardized introductory scripts were used, in both English and French.
  
  
  RESULTS
  CKD clinic structure and models of care vary significantly across Canada. Large variation exists in staffing ratios (Nephrologist, dieticians, pharmacists and nurses to patients), and in referral criteria. Dialysis initiation decisions were usually made by MDs. The majority of clinics (57%) had a consistent model of care (the same Nephrologist and nurse per patient), while others had patients seeing a different nephrologist and nurses at each clinic visit. Targets for various modality choices varied, as did access to those modalities. No patient or provider educational tools describing the optimal time to start dialysis exist in any of the clinics.
  
  
  CONCLUSIONS
  The surveys rely on self reporting without validation from independent sources, and there was limited involvement of Quebec clinics. These are relative limitations and do not affect the main results.
  
  
  CONCLUSIONS
  The variability in clinic structure and function offers an opportunity to explore the relationship of these elements to patient outcomes, and to determine optimal models of care. This list of contacts generated through this study, serves as a basis for establishing a CKD clinic network. This network is anticipated to facilitate the conduct of clinical trials to test novel interventions or strategies within the context of well characterized models of care.
authors.affiliation: University of British Columbia, Vancouver, Canada ; CAnadian KidNey KNowledge TraNslation & GEneration NeTwork (CANN-NET), Calgary, Canada.
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
authors.affiliation: Dalhousie University, Halifax, Canada ; CAnadian KidNey KNowledge TraNslation & GEneration NeTwork (CANN-NET), Calgary, Canada.
authors.forename: Soroka
authors.initials: S
authors.lastname: Steven
authors.affiliation: Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada ; CAnadian KidNey KNowledge TraNslation & GEneration NeTwork (CANN-NET), Calgary, Canada.
authors.forename: Allu
authors.initials: A
authors.lastname: Selina
authors.affiliation: Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada.
authors.forename: Au
authors.initials: A
authors.lastname: Flora
authors.affiliation: Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada ; CAnadian KidNey KNowledge TraNslation & GEneration NeTwork (CANN-NET), Calgary, Canada.
authors.forename: Gil
authors.initials: G
authors.lastname: Sarah
authors.affiliation: Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada ; CAnadian KidNey KNowledge TraNslation & GEneration NeTwork (CANN-NET), Calgary, Canada.
authors.forename: Manns
authors.initials: M
authors.lastname: Braden