title: [Necessary but sometimes complicated coordination of healthcare procedures. The example of chronic renal failure].
abstract: Chronic renalfailure (CRF), one of several disorders involving progressive loss of function of a vital organ, is a paradigm for medical/paramedical coordination networks, especially in view of the explosion of the geriatric CRF/dialysis population. An efficient network is crucial in this setting, given the very high incidence of CRF, its cost, its impact on employment, quality of life and quality of care; and the progression from medical treatment to replacement therapy (peritoneal or hemodialysis) and, eventually, organ transplantation from a living or deceased donor. There is a constant flow of patients entering and exiting care pathways between community practices (public or private), hospitals (general or teaching), medical laboratories, pharmacies (commuity and hospital) and a large number of allied health professions (nurses, social workers, dieticians, physiotherapists, secretaries, etc.). In the predialytic stage of CRF the goal of the network is to establish the diagnosis, slow disease progression, prevent or treat the many potentially complications, inform patients and their families, and postpone the need for dialysis and transplantation. When renal replacement therapy becomes necessary, the choice between peritoneal dialysis and hemodialysis follows strict rules and requires a more technical approach, with predominant involvement of the nephrologist. Finally, transplantation is highly hospital-centered, but patient monitoring in the community requires an approach very similar to that of the predialytic stage, with the involvement of specialists in internal medicine/general practitioners, as the potential complications cover a very broad field of disciplines (infectious, cardiovascular, metabolic, cancer). CRF is a major public health problem that requires a network-based approach involving multiple specialties and skills, the most difficult problem being its coordination. A similar approach can probably be extrapolated to other patients with chronically failing major organs (liver, lungs, heart).
authors.affiliation: Service de Néphrologie, Dialyses, Transplantations, CHU de Bicêtre - Kremlin-Bicêtre et UMR 1014 INSERM/Université Paris Sud - Villejuif.
authors.forename: Bernard
authors.initials: B
authors.lastname: Charpentier
authors.forename: Hélène
authors.initials: H
authors.lastname: François
authors.forename: Séverine
authors.initials: S
authors.lastname: Beaudreuil
authors.forename: Antoine
authors.initials: A
authors.lastname: Dürrbach
mesh_terms: D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D016030:Kidney Transplantation / Q000592:standards; D009934:Organization and Administration; D011634:Public Health / Q000379:methods / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration*; D006435:Renal Dialysis / Q000379:methods / Q000592:standards