Background: Patients with chronic kidney disease are at an increased risk of cardiovascular disease and the associated morbidity and mortality. This patient population is also associated with a substantial cost to the healthcare system with traditional hospital-based care management. The objective of this study is to investigate the cost effectiveness of providing community-based multidisciplinary clinic (MDC) care to this patient population. The goal was to evaluate whether the new model of care is associated with improved patient compliance with medical appointments, and can be delivered effectively within the community in a patient-centred fashion.
Design: In this retrospective analysis, participants in this study included patients started within the local regional program who needed dialysis chronically or until death and were followed for at least 3 months prior to dialysis. Comparison was made between those patients attending a hospital based clinic vs. a community based clinic with respect to optimal and suboptimal start rates, use of internet based educational resources was tracked, potassium, haemoglobin, calcium, phosphorus, PTH levels pre dialysis and patient attendance rates were measured as well.
Results: The results attained from performing this 15-month retrospective analysis showed that this community based model of care yielded similar results with respect to optimal vs. suboptimal start rates, laboratory parameters at initiation of dialysis, and may have been associated with increased rates of attendance to visits.
Conclusions: Our findings show that multidisciplinary care for advanced chronic kidney disease patients can be effectively delivered in a community-based model. This is likely to have significant cost benefits as well as increasing access to care for patients in rural communities or those who prefer to receive their care in a community setting.
Albert Kadri, Maher M El-Masri, Mohammed J Ibrahim, Colleen Bassett and Nicole Dziamarski
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