For patients with moderate to severe chronic kidney disease, a nurse-based model of care decreased costs while enhancing quality of life slightly. A randomized controlled trial of a nurse-coordinated model of care versus usual care in 474 patients with stage 3 and 4 chronic kidney disease in the community was recently reported in two papers in the Clinical Journal of the American Society of Nephrology. The trial was conducted in five centres across Canada (St. Johns, Halifax, Montreal, London and Vancouver). The findings were discussed in the accompanying editorial.
The major conclusions were that patients with moderate to severe chronic kidney disease identified through community laboratories largely had non-progressive kidney disease, probably not requiring follow-up by nephrologists, but had cardiovascular risk, requiring multiple risk factor intervention. Over a median period of 24 months the nurse-coordinated team had a similar impact on control of risk factors as usual care delivered by doctors, and in some instances provided more appropriate use of medications, such as renin angiotensin blockers and statins, in those with high lipid levels. In addition, the nurse-based model provided good value for money as it reduced costs while enhancing quality of life slightly.
The editorial concluded that if the intent of health systems is to address general issues of care co-ordination within a complex medical system, the economic findings of this trial may persuade adoption of nurse-based care, as outlined in this trial, for patients with chronic kidney disease.
More details can be obtained from Barrett BJ et al, CJASN, 6; 1241-1247,2011; Hopkins RB et al, CJASN,6: 1247-1257,2011; and Smith DH and Thorp ML, CJASN,6: 1229-1231,2011.