Virtual Medical Clinic – iConnect CKD St George Hospital Department of Renal Medicine

Virtual medical consulting is a way forward for improving management of patients with chronic conditions and helping them stay in the community. It is a joint method of management with the general practitioner when the patient has early or stable advanced chronic kidney disease (CKD). Research in our department has shown it to be equivalent to nephrologist face-to-face care.

It will hopefully support GPs with opportunistic screening of high risk individuals and follow up by GPs in the community, which is the most sustainable method of care for CKD as with all chronic conditions.

St George Hospital Renal Department initiated virtual medical consulting in 2013 when a pilot study was commenced. Results were as follows:

  • July 2013 - Jan 2015; 70 patients were recruited with informed consent (from GPs and hospital clinics)
  • Reasons for referrals included decline in renal function (54%), uncontrolled hypertension (18%), albuminuria (21%) and haematuria (3%) and symptom control (4%).
  • No difference in baseline demographics or gender for those referred by GPs or directly from the clinic.
  • Albuminuria and eGFR distribution.
  • No difference in outcomes at 12 months (HR).

Qualitative assessment
(Independent evaluation)

  • High level of satisfaction within the GP community
  • Issues with software integration (time consuming)
  • Patients happy with ‘virtual’ model of care
  • Improved time to specialist review.
  • No issues of computer literacy

As the outcomes were positive, and at least no different to ‘standard’ face-to-face clinic care, it was decided we would continue with this model of care.

Patients who are being referred to this form of consultation are those deemed by their nephrologist to be stable CKD patients whose blood pressure is controlled and simply require more ‘active’ tracking.

Before initiating virtual consultations all these patients will have face-to-face consults with their nephrologist at least 12 monthly initially but earlier if required. The ultimate aim will be to track virtually and only see patients again if they show evidence of renal function deterioration or difficult to control hypertension.

The patient will have bloods collected at three to six monthly intervals and the pathology results will be reviewed by the CKD CNC in consultation with their treating nephrologist. We will continue to monitor and evaluate this program, and plan to continue doing more research evaluating its role in patient care. We also look forward to expanding this model of care for other chronic conditions with existing chronic disease services.

Our health care system needs new models of care to deal with the increasing load of chronic conditions in an ageing population.