Chronic kidney failure (CKD) affects a significant proportion of the French population, creating major challenges for the healthcare system. Various initiatives, including those supported by article 43 of the Social Security financing law for 2014, aim to improve the care of these patients.
The context and importance of coordination
Chronic kidney failure, characterized by an inability of the kidneys to properly filter blood, often requires treatments such as dialysis or kidney transplant. In 2021, approximately 92,535 patients in France were in the terminal phase of CKD, requiring dialysis for 55% of them and a functional transplant for the remaining 45% (ABM, 2023). The increase in health expenditure linked to this disease has been notable, reaching 4.18 billion euros in 2017, with an average annual increase of 2.4% from 2013 to 2017 (Cour des Comptes, 2020).
Experiments to improve care pathways
Article 43 of the Social Security financing law for 2014 made it possible to launch experiments in six French regions: Rhône-Alpes, Alsace, Aquitaine, Languedoc-Roussillon, Pays de la Loire and Réunion. These experiments aimed to improve the autonomy and care pathway of patients with kidney failure. The main objectives were to develop prevention and replacement (kidney transplantation and out-of-center dialysis). The pilot projects were focused on two segments: the “pre-replacement” segment for patients in the early phase of the disease and the “replacement” segment for patients already treated by dialysis or transplant.
Recruitment of specialist nurses
The role of coordinating nurses was important in the management of CKD patients. They monitor patients, coordinate care with nephrologists and other health professionals, and play a central role in the therapeutic education of patients. Their presence makes it possible to offer personalized support throughout the care pathway, from the preventive phase to preparation for dialysis or transplant.
Coordinating nurses help reduce the number of emergency dialysis cases by better preparing patients and informing them about different treatment options. They also make it easier for patients to be placed on the transplant waiting list, which is crucial for those who could benefit from a kidney transplant. A nephrologist emphasizes: “Before, these patients were followed by the general practitioner and the nephrologist and these were isolated contacts during the year and between whom it was the black box whereas today, these patients have a therapeutic plan. »
Implementation of communication tools
The implementation of effective communication tools has also played a key role in improving the care of CKD patients. Shared medical records, information exchange platforms and other communication tools have enabled better sharing of information between the different healthcare professionals involved in the care pathway.
These tools have facilitated care coordination, ensuring that all stakeholders have the information needed to make informed, coordinated decisions regarding patient treatment. Interoperability platforms, for example, have made it possible to centralize patients’ biological results, making them easier to read and monitor by different healthcare professionals. A nephrologist said.
« Before, these patients were followed by the general practitioner and the nephrologist and
these were isolated contacts during the year and between which there was a black box whereas today, these patients have a project
therapeutic. » declared a Nephrologist at IRDES
Better quality support
The results of experiments carried out in the six regions show a reduction in dialysis initiated urgently and an increase in access to the transplant waiting list for patients. Although the statistical impact is sometimes limited, these initiatives have opened up new perspectives, particularly in terms of care coordination. The recent expansion of the prevention package to include advanced practice nurses and other professionals such as psychologists and social workers is one example.
The IRDES study demonstrates that the recruitment of specialized nurses and the implementation of communication tools are essential levers for improving the coordination of care and, consequently, the management of patients with insufficiency. chronic kidney disease. These initiatives not only make it possible to better prepare patients for the different stages of their treatment but also to optimize the efficiency of the health system by reducing emergency interventions and improving access to kidney transplants. However, the sustainability of these actions depends on the ability to secure additional funding and to overcome organizational and territorial disparities.
