Web-based consultation between general practitioners and nephrologists: a cluster randomized controlled trial.
Consultation of a nephrologist is important in aligning care for patients with chronic kidney disease (CKD) at the primary-secondary care interface. However, current consultation methods come with practical difficulties that can lead to postponed consultation or patient referral instead.



This study aimed to investigate whether a web-based consultation platform, telenephrology, led to a lower referral rate of indicated patients. Furthermore, we assessed consultation rate, quality of care, costs and general practitioner (GPs') experiences with telenephrology.



Cluster randomized controlled trial with 47 general practices in the Netherlands was randomized to access to telenephrology or to enhanced usual care. A total of 3004 CKD patients aged 18 years or older who were under primary care were included (intervention group n = 1277, control group n = 1727) and 2693 completed the trial. All practices participated in a CKD management course and were given an overview of their CKD patients.



The referral rates amounted to 2.3% (n = 29) in the intervention group and 3.0% (n = 52) in the control group, which was a non-significant difference, OR 0.61; 95% CI 0.31 to 1.23. The intervention group's consultation rate was 6.3% (n = 81) against 5.0% (n = 87) (OR 2.00; 95% CI 0.75-5.33). We found no difference in quality of care or costs. The majority of GPs had a positive opinion about telenephrology.



The data in our study do not allow for conclusions on the effect of telenephrology on the rate of patient referrals and provider-to-provider consultations, compared to conventional methods. It was positively evaluated by GPs and was non-inferior in terms of quality of care and costs.
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
Vincent A
VA
van Gelder
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
Nynke D
ND
Scherpbier-de Haan
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
Saskia
S
van Berkel
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
Reinier P
RP
Akkermans
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
Inge S
IS
de Grauw
Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
Eddy M
EM
Adang
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
Pim J
PJ
Assendelft
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
Wim J C
WJC
de Grauw
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
Marion C J
MCJ
Biermans
Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands.
Jack F M
JFM
Wetzels
D000368:Aged; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D000072104:Nephrologists; D009426:Netherlands; D011320:Primary Health Care; D051436:Renal Insufficiency, Chronic / Q000628:therapy; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*
Chronic kidney disease; patient care management; primary health care; referral and consultation; teleconsultation