Virtual CKD Clinics: A New Approach for Addressing Health Inequality
Difficulty accessing traditional clinics, especially in deprived areas, has led to the proposal of virtual CKD clinics as a more accessible and efficient alternative. By providing holistic care, reducing waiting times, and improving patient satisfaction, virtual clinics aim to bridge gaps in healthcare provision. The proposed process includes piloting clinics, developing referral templates, and seeking funding for rollout.
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Virtual CKD clinics A new approach GP Trailblazer Fellowship Report August 2024 Dr Melanie Morris Salaried GP The Welby Group
Difficulty accessing clinics exacerbated in areas of deprivation tackling health inequality Rising cost of travel and strict eligibility criteria for hospital transport Significant waiting times OP clinics focused and targeted with little opportunity to address other CVD risk factors limited clinical information in referrals, and no access to 1 care medical records. Current A&G is dependant upon how much information the referring clinician provides Recent introduction of automated KFRE makes identification of patients needing 2 care input easier Higher rate of progression of CKD in areas of deprivation (2) Why consider virtual care? (2) CKJ REVIEW Deprivation and chronic kidney disease a review of the evidence Christopher H. Grant 1,2, , Ehsan Salim2, , Jennifer S. Lees 1,2 and Kate I. Stevens 1,
Pilots elsewhere have demonstrated a significantly decreased waiting time from months to days (3) Decrease in the number of patients needing F2F contact Patients cannot DNA Improved diagnosis, management and coding of CKD in 1 care Enhanced knowledge of CKD management in 1 care Decreased environmental impact of travel Potential for improved patient satisfaction and education on how to self-care Potential benefits (3 )https://transform.england.nhs.uk/key-tools- and-info/digital-playbooks/renal-digital- playbook/a-virtual-community-clinic-for-renal- patients-in-east-london/
More holistic care than A&G consultants will have access to the full patient record, so other relevant conditions and risk factors can be identified Moving secondary care out into the community bridging the gap Providing care nearer the patients home. Potential access to Amber drugs under specialist guidance The wider impact
Proposed Process Timeline September 2023 Visit other pilots June 2024 Liaise with 2 care Look at metrics for rollout county-wide Develop referral template and clinic template within sysone Seek potential further funding Develop system to consent patients Develop and amend model for rollout November 2023 Start pilot clinics Lead GP, Consultant and ? Lead PN Scope numbers ? Invite all Gainsborough surgeries Re-assess and amend process as needed
Progress Sept Dec 2023 Multiple calls and meetings with several teams nationally discussing successes and pitfalls of current, similar projects. Contacts made with teams from St Barts (London),and LUCID team (Leics and Rutland). Regular updates with Dr Matt Williams Consultant Nephrologist to discuss best framework and structure for clinics and decide on referral/exclusion criteria. Development of predetermined systmone searches to identify relevant patients for clinic based on NICE guidelines for referral to 2 care based on eGFR, uACR and KFRE. Development of vCKD clinic referral template within systmone.
vCKD clinic systmone teferral template Relevant patients identified via predetermined search criteria based on KFRE,eGFR or abnormal uACR results (NICE guidelines for referral). Template automatically populates relevant clinical data such as latest eGFR, uACR and KFRE. Text box for clinicians to enter clinical concerns/queries Minimal exclusion criteria Automation of SMS to patient if patient unaware of referral at the time of completion. Once referral completed, patients are saved on a vCKD report until date of clinic.
vCKD clinic documentation template Text box for documenting clinic discussion and management plan Multiple outcome options Template includes link to CKD formulary for ease of prescribing Automation of tasks on completion of template to inform referring clinician of outcome
Monthly vCKD clinics held via teams between Dr Morris and DR Williams for all Welby Group patients. 57 Welby patients reviewed in vCKD clinic to date. April 2024 contact make with Trent PCN to offer vCKD to all PCN surgeries. April June 2024 Onboarding Trent PCN July 2024 First Trent PCN vCKD clinic completed. Progress January 2024 Present Day
Plans for the future To seek support and guidance from other organisations re: ongoing funding and development e.g short term grant, liaising with LUCID re: expanding their rollout. To continue to build on improving format and structure of clinics to maximise efficiency and outcome for patients and clinicians. Process and analyse current date to establish if there has been any improvement in patient outcomes e.g. KFRE, uptake of ACEI/SGLT2i.
