Abstract: SA-PO1106
Progress Against Progression? CKD Management in the Age of Telenephrology
Session Information
- CKD Epidemiology, Risk Factors, Prevention - III
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Scherzer, Zachary A., University of Wisconsin Hospital and Clinics, Madison, Wisconsin, United States
- Lesnik, Dyan M., William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States
- Maursetter, Laura J., University of Wisconsin Hospital and Clinics, Madison, Wisconsin, United States
Background
Nephrology has seen an uptick in transition to remote care delivery, but there has been limited direction for optimal selection of patients appropriate for this method of care. Furthermore, there is limited literature to show which profile of patients utilize the telenephrology platform. In this study, we report the baseline population differences between telenephrology and in-person care groups that are naturally selected when this option is available.
Methods
Single center retrospective cohort analysis involving 1,305 patients seen across 4,230 visits over a 3-year period at a well-established nephrology clinic within the Veterans Affairs health system. Baseline characteristics and health profile data were assessed based on grouping of individuals to the telenephrology group (>50% virtual visits) or in-person group (≤50% virtual visits).
Results
Baseline characteristics including demographic information and comorbid conditions were similar between the two groups. A higher preponderance of those living in rurally defined areas, as compared to those in urban settings, were found to receive in-person care. Individuals who received in-person care were noted to have twice as many emergency department (ED) visits and hospitalizations throughout the course of the study. Similarly, those seen in-person were significantly more likely to be referred for hospice/palliative services.
Conclusion
Understanding the health profiles of those who receive telenephrology versus in-person care can inform future decision-making for appropriate utilization. It was surprising to see a higher degree of telemedicine visits occurring with individuals residing in urban locations. Discomfort with aspects of technology and/or lack of reliable internet for those living in rural areas are possible factors implicated in this. More surprising was the increase in ED visits, hospital admissions, and palliative care by those seen in-person. It could be that those seen in-person were more ill, this was a use of convenience due to proximity, or that care is being missed with telenephrology. These finding makes future research on the cause of these differences, as well as the impact of telenephrology on CKD progression, imperative.