Original InvestigationPathogenesis and Treatment of Kidney Disease and HypertensionAn Evaluation of a Shared Primary and Secondary Care Nephrology Service for Managing Patients With Moderate to Advanced CKD
Section snippets
The SIMON Programme
The SIMON Programme started in 1993 and provides specialist nephrology care for the population of the former Southampton and South West Hampshire Health Authority, a mixed urban/rural area of the United Kingdom with a catchment population of approximately 400,000. In addition to managing patients in the HC, the SIMON Programme has a shared primary and nephrology care scheme (SCS; Fig 1). In this scheme, patients considered by nephrologists to be stable and uncomplicated are enrolled in the SCS,
Baseline Characteristics
At referral, patients were elderly (median age, 75 years) and 61% were men (Table 1). Vascular disease and diabetic nephropathy were present in 42% and 16% of patients, respectively. Relatively few patients in all groups met UK Renal Association guidelines for systolic (<140 mm Hg) and diastolic (<80 mm Hg) blood pressure at referral.
Two hundred sixty-six of 949 new referrals (28%) were enrolled in the SCS, 154 (58%) within 6 months (SCS <6 months) and 112 (42%) after 6 months of first
Discussion
In this retrospective review of a single nephrology center, nearly 30% of patients with moderate to advanced CKD and better prognostic factors were selected for enrollment in an SCS. They were managed successfully without face-to-face contact with nephrologists despite almost one third having advanced renal disease. More than half of those enrolled in the SCS did so within 4 months of first presentation to nephrology services, and although other patients (SCS >6 months) required a median of 18
Acknowledgment
The authors thank the British Renal Society for providing a research grant to fund this work; Dr Rodney Dathan for advice about the SCS; Natasha Wilson, the SIMON database manager, for invaluable assistance with this review; and the editors and anonymous reviewers for their helpful comments.
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Originally published online as doi:10.1053/j.ajkd.2005.09.020 on November 18, 2005.
Support: British Renal Society project grant. Potential conflicts of interest: None.