ABSTRACT
Telemedicine has significant potential to extend nephrology consultation to rural and isolated communities. We describe a telenephrology clinic that has delivered ongoing consultative care from a nephrologist based at the National Institutes of Health in Bethesda, MD, to the Zuni Comprehensive Health Center in western New Mexico. Over the past 9 years, the clinic has conducted 1870 patient visits managing patients using a collaborative approach engaging a nurse case manager, nephrologist, primary clinicians, pharmacists, and community health nurses. A significant proportion of the care provided is directed toward patients with advanced kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m2). Although there are unique aspects to the Indian Health Service and to the Zuni community which is served by this clinic, this telemedicine clinic does serve as a demonstration that nephrologic consultative care can be delivered effectively and efficiently to rural high-risk communities using a collaborative and integrated model of care.
Subject(s)
Delivery of Health Care/organization & administration , Diabetic Nephropathies/therapy , Nephrology , Renal Insufficiency, Chronic/therapy , Telemedicine/organization & administration , Ambulatory Care/organization & administration , Case Managers , Disease Management , Humans , National Institutes of Health (U.S.) , Nephrologists , New Mexico , Nurses, Community Health , Severity of Illness Index , United States , United States Indian Health Service/organization & administrationABSTRACT
: Coping with chronic kidney disease (CKD) is challenging for many people, since symptoms often don't appear until the disease is advanced and the patient is close to requiring dialysis. This two-part article aims to provide nurses with the basic information necessary to assess and manage patients with CKD. Part 1, which appeared last month, offered an overview of the disease, described identification and etiology, and discussed ways to slow disease progression. Part 2 addresses disease complications and treatment for kidney failure.
Subject(s)
Kidney Failure, Chronic/nursing , Treatment Outcome , Acidosis/etiology , Anemia/etiology , Bone Diseases/etiology , Disease Progression , Education, Nursing, Continuing , Humans , Hyperkalemia/etiology , Kidney Failure, Chronic/complications , Kidney Transplantation , Minerals/metabolism , Renal Replacement Therapy , Serum Albumin/analysisABSTRACT
: The burden of chronic kidney disease (CKD) is rising both in this country and worldwide. An estimated 10% to 15% of U.S. adults are currently living with CKD. Reducing the CKD burden requires a systematic, interdisciplinary approach to care. The greatest opportunities to reduce the impact of CKD arise early, when most patients are being followed in primary care; yet many clinicians are inadequately educated on this disease. Nurses are well positioned to facilitate the implementation of collaborative care. This two-part article aims to provide nurses with the basic information necessary to assess and manage patients with CKD. Part 1 offers an overview of the disease, describes identification and etiology, and discusses ways to slow disease progression. Part 2, which will appear next month, addresses disease complications and treatment of kidney failure.
