#6431 THE DEVELOPMENT OF AN INTEGRATED COMMUNITY, CONSERVATIVE KIDNEY CARE AND PALLIATIVE-RENAL CARE SERVICE
Authors: Ahmed Jawad , Birch Lucia , Dodd Matthew , Roberts Donna , Harlin Simon , Mahmoud Huda 
Published: June 2023

Abstract

Background and Aims
Conservative kidney care is the chosen therapeutic strategy for approximately 6% of renal patients. It is estimated that a third of renal units in the United Kingdom have a dedicated conservative kidney care service. Equally, other units manage this cohort of patients in general nephrology/ low-clearance clinics or alternatively, discharge to community services. Walsall Together, is a collaborative initiative between community and speciality services, driven to provide multi-agency, patient-focused care. By combining specialist input and community resources, we aimed to optimally manage individuals on the conservative kidney care and palliative-renal pathways at home.

Method
Community, nephrology and palliative care teams devised a service for those individuals identified for conservative kidney care or individuals with renal disease requiring palliative care management. Two separate, yet linked services; the community, conservative care pathway feeding into the community, palliative-renal pathway. Individuals suitable for community conservative care pathway were identified from routine nephrology inpatient and outpatient workstreams. Prior to a telephone consultation with a nephrologist, phlebotomy for routine bloods were performed at the GP surgery or at the patients home by the community phlebotomy service. Any alterations to medications would be performed directly by the community pharmacist. Symptoms were assessed using the integrated palliative outcome score (IPOS)-renal survey. The IPOS renal-survey asks individuals to rate symptom burden from; not at all, to slightly, moderately, severely and overwhelmingly. Home visits were offered to unwell or symptomatic patients. Individuals requiring palliative care were identified from both palliative and nephology services. A bi-weekly palliative-renal multidisciplinary team (MDT) meeting was established.

Results
To date 40 individuals have been managed on both the community conservative care and renal-palliative care pathway. 94% of patients felt that the community approach did not waste time waiting for appointments/treatments. 87% of patients felt that the community approach provided them with sufficient information to understand their healthcare condition and relevant management strategies. Patients reported pain, nausea and reduced appetite as the three most common symptoms that generated discomfort in the three days prior to taking the IPOS-renal survey. On detailed assessment; significant symptom burden was attributed to reduced mobility (82% scoring slightly to overwhelmingly), pain (65% scoring slightly to overwhelmingly) and bowel concerns (65% scoring slightly to overwhelmingly). Itching affected a third of the cohort, scoring moderately to overwhelmingly. Importantly, as a result of the service, patients reported that either all or most renal-related problems were addressed. To date all patients who died while under the renal-palliative care service, died in their chosen place of death, and not in hospital.

Conclusion
The Walsall Together initiative has demonstrated that utilising a collaborative approach to managing complications of advanced kidney disease can result in the reduction of hospital admissions, face-to-face hospital outpatient appointments and time wasted attending healthcare appointments. Furthermore, the cooperative multi-speciality approach, has led to improve patient satisfaction and the attainment of patient healthcare goals.