BACKGROUND Early identification of people with CKD in primary care, particularly those with risk factors such as diabetes and hypertension, enables proactive management and referral to specialist services for progressive disease. The 2019 NHS Long Term Plan endorses the development of digitally-enabled services to replace the 'unsustainable' growth of the traditional out-patient model of care.Shared views of the complete health data available in the primary care electronic health record (EHR) can bridge the divide between primary and secondary care, and offers a practical solution to widen timely access to specialist advice. METHODS We describe an innovative community kidney service based in the renal department at Barts Health NHS Trust and four local clinical commissioning groups (CCGs) in east London. An impact evaluation of the changes in service delivery used quantitative data from the virtual CKD clinic and from the primary care electronic health records (EHR) of 166 participating practices. Survey and interview data from health professionals were used to explore changes to working practices. RESULTS Prior to the start of the service the general nephrology referral rate was 0.8/1000 GP registered population, this rose to 2.5/1000 registered patients by the second year of the service. The majority (> 80%) did not require a traditional outpatient appointment, but could be managed with written advice for the referring clinician. The wait for specialist advice fell from 64 to 6 days. General practitioners (GPs) had positive views of the service, valuing the rapid response to clinical questions and improved access for patients unable to travel to clinic. They also reported improved confidence in managing CKD, and high levels of patient satisfaction. Nephrologists valued seeing the entire primary care record but reported concerns about the volume of referrals and changes to working practices. CONCLUSIONS 'Virtual' specialist services using shared access to the complete primary care EHR are feasible and can expand capacity to deliver timely advice. To use both specialist and generalist expertise efficiently these services require support from community interventions which engage primary care clinicians in a data driven programme of service improvement.

中文翻译：

---

虚拟肾脏诊所会改善肾脏护理服务吗？对东伦敦虚拟诊所的初步影响评估。

背景技术早期识别出具有初级保健中的CKD的人，特别是那些具有诸如糖尿病和高血压等危险因素的人，能够进行积极的治疗并转诊至进行性疾病的专科服务。2019年NHS长期计划认可了数字化服务的发展，以取代传统门诊医疗模式的``不可持续''增长。初级医疗保健电子健康记录（EHR）中提供的完整健康数据的共享观点可以弥合初级保健和二级保健之间的鸿沟，并提供实用的解决方案，以扩大及时获得专家建议的机会。方法我们描述了一种创新的社区肾脏服务，该服务基于Barts Health NHS Trust的肾脏科和伦敦东部的四个本地临床委托小组（CCG）。对服务交付变化的影响评估使用了来自虚拟CKD诊所和166个参与实践的初级保健电子健康记录（EHR）的定量数据。来自卫生专业人员的调查和访谈数据被用来探索工作习惯的变化。结果在开始服务之前，一般的肾脏病转诊率为0.8 / 1000 GP注册人口，到服务第二年，这一数字上升到2.5 / 1000 GP注册病人。大多数（> 80％）不需要传统的门诊预约，但可以通过为转诊临床医生提供书面建议进行管理。等待专家建议的时间从64天减少到6天。全科医生（GP）对该服务持积极态度，评估对临床问题的快速反应，并改善无法前往诊所的患者的出入途径。他们还报告说，他们在管理CKD方面的信心有所提高，并且患者满意度很高。肾脏科医生重视查看整个初级保健记录，但对转诊数量和工作方式变化表示担忧。结论通过共享访问完整的初级保健EHR的“虚拟”专家服务是可行的，并且可以扩展提供及时建议的能力。为了有效地利用专家和通才专家的技能，这些服务需要社区干预的支持，这些干预使初级保健临床医生参与了数据驱动的服务改进计划。肾脏科医生重视查看整个初级保健记录，但对转诊数量和工作方式变化表示担忧。结论通过共享访问完整的初级保健EHR的“虚拟”专家服务是可行的，并且可以扩展提供及时建议的能力。为了有效地利用专家和通才专家的技能，这些服务需要社区干预的支持，这些干预使初级保健临床医生参与了数据驱动的服务改进计划。肾脏科医生重视查看整个初级保健记录，但对转诊数量和工作方式变化表示担忧。结论通过共享访问完整的初级保健EHR的“虚拟”专家服务是可行的，并且可以扩展提供及时建议的能力。为了有效地利用专家和通才专家的技能，这些服务需要社区干预的支持，这些干预使初级保健临床医生参与了数据驱动的服务改进计划。