title: Improving nephrology service delivery - Accessing the specialist.
abstract: BACKGROUND
  The increased prevalence of chronic kidney disease (CKD) is straining the medical workforce and healthcare budget. To improve efficiency, patients require streamlined access to renal and general practice specialist advice.
  
  
  OBJECTIVE
  The aim of this article is to profile general practitioner (GP) referrals for patients with CKD and compare these referrals to national guidelines.
  
  
  METHODS
  We conducted a retrospective analysis of 200 randomly selected outpatient referrals to the renal service at St George Hospital, Sydney, between 2008 and 2011. These referrals were compared against national referral guidelines.
  
  
  RESULTS
  Declining renal function accounted for the majority (44%; n = 78) of referrals, while advice regarding hypertension management contributed to a further 21% (n = 38) of referrals. Fifteen per cent (n = 27) of patients were referred back to their GP after one visit, while 40% (n = 72) required follow-up beyond 12 months. When compared with the National nephrology referral guidelines, 25% (n = 42) of referrals did not meet the criteria.
  
  
  CONCLUSIONS
  Access to renal specialists may be difficult because of bottlenecks in the public clinic, frustrating all parties concerned. If an alternative, more integrated, possibly web-based CKD support service existed, some formal reviews could be bypassed. This study provides preliminary data supporting the development of such a service, and simultaneously providing streamlined sup-port to the GP and relieving pressure on hospital clinics.
authors.forename: Cathie
authors.initials: C
authors.lastname: Lane
authors.forename: Saiyini
authors.initials: S
authors.lastname: Pirabhahar
authors.forename: Jennifer
authors.initials: J
authors.lastname: Robins
authors.forename: Shelley
authors.initials: S
authors.lastname: Tranter
authors.forename: Mark
authors.initials: M
authors.lastname: Brown
authors.forename: Ivor
authors.initials: I
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D003695:Delivery of Health Care; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000706:statistics & numerical data*; D009517:New South Wales; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies