Abstract: SA-PO1109
Initiatives to Enhance the Quality of Referrals from Primary Care to Nephrology: A Systematic Review
Session Information
- CKD Epidemiology, Risk Factors, Prevention - III
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Ghimire, Anukul, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Ye, Feng, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Hariramani, Vinash Kumar, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Abdulrahman, Abdullah, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Tungsanga, Somkanya, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Okpechi, Ikechi G., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Bello, Aminu K., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
Background
Excessive referrals to nephrology are major determinants for prolonged wait times to access specialist kidney care. We conducted a systematic review of initiatives aimed at improving the quality of referrals to the nephrology service.
Methods
Studies published from inception to April 1, 2021, that were designed to increase guideline concordant (GC) referrals or to reduce wait times and/or total referrals of adult patients with chronic kidney disease from primary care (PCP) to nephrology services were included. The primary outcomes of interest were changes to wait times, changes in the total number of referrals, and changes in the proportion of guideline-concordant referrals. The review was performed using a pre-specified protocol and reported using the PRISMA model. The results are reported based on taxonomy of interventions (provider education, provider reminder system, audit and feedback, multiple interventions, and other).
Results
27 studies met eligibility criteria, including 16 pre-post designs, 5 observational studies, 3 interrupted time series studies, and 2 randomized control trials. Among 6 studies that provided information on the relative change in total referrals after an intervention was applied, the proportionate change in total referrals was 15.3% [IQR: -16.7-80.6%]. 8 studies showed an increased trend in absolute number of referrals for the study periods with a median 23.2 [IQR, 22.0-56.2]. Among four pre-post design studies that reported the mean change in wait times, a significant reduction in the overall wait time was noted (median -26.3 [IQR, -104.2-1.6] days). Three studies used multiple interventions per each initiative, and two of these studies showed a relative increase by 11-fold in GC referrals pre and post intervention.
Conclusion
Practice-based initiatives designed to improve the quality of referrals from PCP to nephrology services had different effects on their outcomes of interest. It appears that multifaceted interventions are more appropriate for a greater impact as no single intervention in our study showed a greater effect over another on reducing wait times, absolute number of referrals, or proportion of GC referrals.