It is estimated that up to 8% of British Columbians have potentially significant chronic kidney disease (CKD). Many of these patients are also affected by heart disease and diabetes as CKD increases the normal risk of cardiac morbidity by 10 times. Fully 40% of patients on dialysis also have diabetes.
The ability of GPs to manage care for patients with chronic conditions often depends on effective communication and exchange of knowledge with specialist colleagues. The BCMA and Ministry of Health Services have highlighted the importance of effective physician-to-physician communication through recent updates to fee schedules that facilitate inter-provider contact. Strategic alignment of compensation with point-of-care health care processes provides appropriate incentives to enhance interaction among participating physicians and represents a philosophical shift toward a shared care model.
Shared care refers to a set of ideas designed to facilitate collaboration between GPs and specialists. The benefits are thought to include reduced patient wait times for specialist care by minimizing the amount of primary care provided by specialists, a decrease in inappropriate consultations, less duplication of testing and fewer unnecessary prescriptions, and increased communication and knowledge exchange between specialists and GPs.
Shared care also seeks to open ongoing dialogue between specialists and GPs to more effectively define roles and mutual expectations and ensure that patients do not “fall through the cracks.”
In support of shared care, the British Columbia Provincial Renal Agency (BCPRA) has developed a program to engage GPs and nephrologists toward improving care for patients with kidney disease. Within this program, one initiative has focused on studying wait times for outpatient nephrology assessment, while a second is aimed at providing opportunities for GPs to upgrade their knowledge of nephrology care.
These initiatives are timely in view of the epidemic prevalence of CKD, which is estimated to affect more than 2 million Canadians. The Table shows the projected CKD prevalence figures for BC by health authority.
While the projected total outpatient demand of approximately 360000 patients may include some non-progressers who do not need to see a nephrologist, the most conservative estimate of true outpatient CKD demand suggests close to 200000 British Columbians live with high-risk CKD stage 3 to 4. At the same time, BC has only about 50 full-time nephrologists. It is clear that provision of effective early CKD care by primary care physicians is needed to optimize outcomes for these patients.
To help GPs manage the increasing number of CKD patients in their practices, the BCPRA has developed a nephrology curriculum with objectives derived from a formal survey of GP’s educational needs. The first annual GP nephrology course has been approved by the College of Family Physicians of Canada for 6.5 Mainpro-1 CME credits. It will be held Saturday, 22 January 2010 at the Wosk Centre for Dialogue in downtown Vancouver. More information is available at www.bcrenalagency.ca/default.htm.
—Michael Schachter, MD
1. Hickman M, Drummond N, Grinshaw J. A taxonomy of shared care for chronic disease. J Public Health Med. 1994;16:447-454.
2. Stigant C, Stevens L, Levin A. Nephrology: 4. Strategies for the care of adults with chronic kidney disease. CMAJ 2003;168:1553-1560.
3. Coresh J, Selvin E, Stevens LA. Prevalence of chronic kidney disease in the United States. JAMA 2007;298:2038-2047.
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