Introduction:
Six percent of individuals with kidney disease choose conservative care as the end-stage renal failure therapeutic strategy. It is estimated that only a third of renal units in the United Kingdom have a dedicated service for conservative care. Equally, other units manage this cohort of patients in general nephrology/ low-clearance clinics or alternatively, discharge to community services. Walsall Together, is a collaborative initiative between community and speciality services, driven to provide multi-agency, patient-focused care. By combining specialist input and community resources, we aimed to optimally manage individuals on the conservative kidney care and palliative-renal pathways at home.
Methods:
Community, nephrology and palliative care teams devised a service for those individuals identified for conservative kidney care or individuals with renal disease requiring palliative care management.
Individuals suitable for community conservative care pathway were identified from nephrology or palliative inpatient and outpatient workstreams. Phlebotomy for routine bloods were performed at the GP surgery or at the patients’ home by the community phlebotomy service prior to a telephone consultation with a member of the nephrology team. Any alterations to medications would be performed directly by the community pharmacist. Symptoms were assessed using the integrated palliative outcome score (IPOS)-renal survey. The IPOS renal-survey asks individuals to rate symptom burden from; not at all, to slightly, moderately, severely and overwhelmingly. Home visits were offered to symptomatic patients.
A bi-weekly palliative-renal multidisciplinary team (MDT) meeting was established to support individuals with evolving or unstable palliative symptoms or those requiring enhanced social support.
Results:
To date 55 individuals have been managed using these services. 94% of patients felt that the community approach did not waste time waiting for appointments/treatments. 87% of patients felt that the community approach provided them with sufficient information to understand their healthcare condition and relevant management strategies. Patients reported pain, nausea and reduced appetite as the three most common symptoms that generated discomfort in the three days prior to taking the IPOS-renal survey. On detailed assessment; significant symptom burden was attributed to reduced mobility in 4 in 5 service-users, pain and bowel concerns in 3 in 5 service users. Itching affected a third of the cohort. Importantly, as a result of the service, patients reported that either all or most renal-related problems were addressed. The majority of service-users died in their chosen place of death.
Conclusions:
The Walsall Together initiative has demonstrated that utilising a collaborative approach to managing complications of advanced kidney disease can result in the reduction of hospital admissions, face-to-face hospital outpatient appointments and time wasted attending healthcare appointments. Furthermore, the cooperative multi-speciality approach, has led to improve patient satisfaction and the attainment of patient healthcare goals.
I have potential conflict of interest to disclose.
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I did not use generative AI and AI-assisted technologies in the writing process.