Web-based consultation between general practitioners and nephrologists: a cluster randomized controlled trial
Open accessAbstract
Background: Consultation of a nephrologist is important in aligning care for patients with chronic kidney disease (CKD) at the primary-secondary care interface. However, current consultation methods come with practical difficulties that can lead to postponed consultation or patient referral instead. Objective: This study aimed to investigate whether a web-based consultation platform, telenephrology, led to a lower referral rate of indicated patients. Furthermore, we assessed consultation rate, quality of care, costs and general practitioner (GPs') experiences with telenephrology. Methods: Cluster randomized controlled trial with 47 general practices in the Netherlands was randomized to access to telenephrology or to enhanced usual care. A total of 3004 CKD patients aged 18 years or older who were under primary care were included (intervention group n = 1277, control group n = 1727) and 2693 completed the trial. All practices participated in a CKD management course and were given an overview of their CKD patients. Results: The referral rates amounted to 2.3% (n = 29) in the intervention group and 3.0% (n = 52) in the control group, which was a non-significant difference, OR 0.61; 95% CI 0.31 to 1.23. The intervention group's consultation rate was 6.3% (n = 81) against 5.0% (n = 87) (OR 2.00; 95% CI 0.75-5.33). We found no difference in quality of care or costs. The majority of GPs had a positive opinion about telenephrology. Conclusion: The data in our study do not allow for conclusions on the effect of telenephrology on the rate of patient referrals and provider-to-provider consultations, compared to conventional methods. It was positively evaluated by GPs and was non-inferior in terms of quality of care and costs.
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Van Gelder 2017 found little or no difference between groups for providers' adherence to advised monitoring criteria from national CKD guidelines, as measured by monitoring of disease progression and metabolic parameters (3004 participants; moderate-certainty evidence).
“The authors found little or no difference for providers' adherence to the advised monitoring criteria from national CKD guidelines, as measured by monitoring of disease progression and metabolic parameters (3004 participants; moderate‐certainty evidence; Analysis 1.1).”
From Mobile technologies to support healthcare provider to healthcare provider communication and management of care (2020) · cites this paper as Van Gelder 2017
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Experimental — accuracy not yet measuredVan Gelder 2017 found little or no difference between groups for referral rate (OR 0.61, 95% CI 0.31 to 1.23; 3004 participants).
“One trial of eConsults between PCPs and nephrologists reported that there was little or no difference between groups for referral rate (odds ratio (OR) 0.61, 95% CI 0.31 to 1.23; Van Gelder 2017; 3004 participants).”
From Mobile technologies to support healthcare provider to healthcare provider communication and management of care (2020) · cites this paper as Van Gelder 2017
Eminović 2009 and Van Gelder 2017 reported little or no difference between groups for costs (Eminović 2009: MD EUR 32.5, 95% CI −29.0 to 74.7, 605 participants; Van Gelder 2017: IG EUR 453.86, 95% CI 392.98 to 514.74; CG EUR 433.74, 95% CI 387.64 to 479.84, P = 0.60; 3004 participants).
“Two trials (teledermatology and telenephrology, respectively) reported little or no difference between groups for costs (Eminović 2009, 605 participants; MD EUR 32.5, 95% CI −29.0 to 74.7; Van Gelder 2017; 3004 participants; IG: EUR 453.86, 95% CI 392.98 to 514.74; CG EUR 433.74, 95% CI 387.64 to 479.84, P = 0.60).”
From Mobile technologies to support healthcare provider to healthcare provider communication and management of care (2020) · cites this paper as Van Gelder 2017
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- Authors
- van Gelder, V. A., Scherpbier-de Haan, N. D., van Berkel, S., Akkermans, R. P., de Grauw, I. S., Adang, E. M., Assendelft, P. J., de Grauw, W. J. C., Biermans, M. C. J., & Wetzels, J. F. M.
- Affiliations
- Radboud University Medical Center (NL)
- Venue
- Family Practice
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-02-02
- Volume
- 34
- Issue
- 4
- Pages
- 430-436
- ISSN
- 0263-2136 (ISSN-L)
- 1460-2229
- OpenAlex
- W2584231885
- Semantic Scholar
- f1839c14aec59601c34b266ac9940575a97db0e9
- Cited by
- 32
- References
- 20
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 6 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 6 · 2019: 2 · 2018: 4 · 2017: 1
- FWCI
- 6.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Family Practice (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Amgen
- Nierstichting
- Topics
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- telenephrology, teleconsultation, chronic kidney disease, general practitioners, nephrologists, referral rates, primary-secondary care interface, consultation rates, quality of care, health care costs, GP experiences, telemedicine
- MeSH terms
- Nephrologists, Aged, Female, Humans, Male, Netherlands, Primary Health Care, Surveys and Questionnaires, Telemedicine, Renal Insufficiency, Chronic, General Practitioners
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