Referral patterns to renal services: what has changed in the past 4 years?
Referral patterns to renal services: what has changed in the past 4 years?
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DOI：
10.1093/ndt/gfp289
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发表时间：
2009-11-01
影响因子：
6.1
通讯作者：
Farmer, Christopher
中科院分区：
文献类型：
--
作者：
Hobbs, Helen;Stevens, Paul;Farmer, Christopher
背景资料。自2002年以来，几项大型流行病学研究的发表促进了人们对慢性肾脏疾病(CKD)的认识。这导致了早期识别和管理慢性肾脏病的各种举措，包括自2006年4月起在初级保健质量和结果框架(QOF)中引入自动肾小球滤过率(GFR)报告和肾脏指标。这些举措旨在促进对慢性肾脏病的识别，并对肾脏服务的转诊模式产生了影响。这项研究的目的是在120万人口的集水区人口中了解这种影响的性质。收集和记录了2004年4月1日至2008年3月31日期间所有初级保健书面转诊的数据。使用Microsoft MapPoint 2004绘制了每个邮政编码部门的转介模式。运用小区域分析技术模拟了机率对推荐模式的影响。从QOF数据中报告的CKD患病率与估计的CKD患病率之间的关系在邮编地区水平进行了检验。在采取这些举措之前的两年里，有1461人被转介，在实施后的两年里，有2890人被转介。两组患者转诊的主要原因都是肾功能受损或既往已确诊的肾脏疾病。据报道，两组之间的共病情况相似。图谱显示，在研究的前两年，转诊行为存在广泛的异质性，在第二个时期较少。小区域分析表明，导致在两个研究期间观察到的极端商数的变化并不是仅仅由于转介模式的随机变化。CKD报告患病率与转诊率之间无相关性。转诊模式在2004年4月1日至2008年3月31日期间发生了变化。主要结果是转诊率和转诊年龄有所增加，但报告的被转诊者的共病情况没有显着变化。转诊率的主要增加见于更晚期的慢性肾脏病，这表明更有针对性地将慢性肾脏病患者转诊到肾脏服务。
Background. Awareness of chronic kidney disease (CKD) has been prompted by the publication of several large epidemiological studies since 2002. This has led to various initiatives for the early identification and management of CKD, including the introduction of automated glomerular filtration rate (GFR) reporting and renal indicators in the primary care quality and outcomes framework (QOF) since April 2006. These initiatives were intended to promote identification of CKD and have had an impact on referral patterns to renal services. The aim of this study was to understand the nature of this impact in a catchment population of 1.2 million people.Methods. Data were collected and recorded from all written referrals from primary care between 1 April 2004 and 31 March 2008. Referral patterns for each postcode sector were mapped using Microsoft MapPoint 2004. The effect of chance on referral patterns was modelled by using small area analysis techniques. The association between the CKD prevalence reported from QOF data and the estimated CKD prevalence was examined at post-code district level.Results. There were 1461 referrals in 2 years prior to the introduction of the initiatives and 2890 referrals in the 2 years post-introduction. The main reason for referral in both groups was impaired renal function or previously established renal disease. Reported comorbidity was similar between the groups. Mapping showed that there was wide heterogeneity in referral behaviour in the first 2 years of the study, which was less in the second period. Small area analysis suggested that the variation that led to the extremal quotients observed in both of the study periods was not due to random variation in referral pattern alone. There was no correlation between the reported CKD prevalence and the referral rates.Conclusion. Referral patterns have changed between I April 2004 and 31 March 2008. The main findings were an increase in referral rate and in the age at referral without a significant change in reported comorbidity of the people referred. The main increase in referral rates was seen in more advanced CKD suggesting more targeted referral of patients with CKD to renal services.