VIRTUAL COMMUNITY NEPHROLOGY MDT: A INNOVATIVE WAY TO REDUCE HOSPITAL ATTENDANCE AND ADMISSION.

Introduction:

The community-nephrology multidisciplinary team (MDT) service aims to manage individuals with chronic kidney disease (CKD), without the need to attend hospital appointments. This initiative aligns with the NHS long-term plan to cut face-to-face outpatient appointments by a third, easing time, financial, and travel burdens on patients and potentially saving the national health service approximately one billion pounds annually. 

Methods:

Virtual community-nephrology MDTs are conducted weekly and include a MDT coordinator, advanced care practitioners, pharmacist, nephrologist and a specialist nephrology nurse. Individuals are selected from nephrology outpatients, inpatients and community cohorts. Bloods/ urine albumin creatinine ratio (UACR) are performed by community phlebotomists or at the general practitioner (GP), blood pressures (BP) and weights are performed by the patient or GP. MDT interventions included optimising CKD management, addressing polypharmacy, and escalation planning. Service-users' data was collected 12-months prior and post-MDT intervention. 

Results:

234 individuals' information were collected from April 2023 to date. 134 male, mean age 81.1 +/- 13.1 years, 67.8% with CKD stage 4. Table 1 demonstrates the group mean clinical and biochemical data for the cohort. The biochemical data were all within target range with 25% requiring treatment for acidosis and 15% for renal anaemia. 62% of the population achieved target BP, 45% had UACR performed within 12-months of commencing the MDT. 62.6%, 57.3% and 32.2% were assessed for administration of statins, renin-aldosterone-system inhibition and sodium/glucose co-transporter-2 inhibitors respectively. Median admission rate dropped from 1(IQR 0,3) to 0 (IQR 0,1), p<0.0001 post-intervention. There was an improvement in the rate of renal decline from –3.48+/- 13.5ml/min/1.73m2 to –0.01 +/- 9.63ml/min/1.73m2, p=0.007.

Conclusions:

The virtual multi-specialty approach can effectively manage CKD and led to improved outcomes with a reduction in admissions and GFR decline. The service requires further input to streamline and optimise the outcomes for CKD patients, particularly UACR acquisition.  

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.