The Importance of Earlier-Stage Kidney Care and Why PCPs are the Key.

Elise:

I know that you’re not personally involved in The UCLA Kidney Health Program but wanted to get your perspective on some of its work on behalf of patients diagnosed with chronic kidney disease (CKD).

UCLA describes the program as a multi-discipline effort working to bring new and innovative techniques to a range of kidney health issues with the goal of preserving and even improving function. They refer to this model
of care as Kidney Function Preservation.

When reading about the Program, I was struck by the fact its focus is on the later stages of kidney disease (stages 4-5) although its stated goal is to preserve function. I was curious as to why more is not being done at the earlier-intervention stages (stages 1-3). Can you provide us with some insight as to why that might be the case?

Dr. Norris:

That’s a great question. The quick answer is that many of these initiatives or similar ones arise out of nephrology. Based on the structure of the medical community, and how patient referrals tend to work, nephrology tends to focus on the later stages of kidney disease. Of course, nephrologists do try to participate in the education of patients who are in the earlier stages. Clearly, PCPs and the pharmacists can have the greatest impact in the earlier stages, as they are the first/direct line to patients.

Elise:

The Centers for Disease Control and Prevention (CDC) reports that there are thirty-seven million U.S. adults who have chronic kidney disease (CKD), approximately 90% of whom are in the early stages of the disease, typically cared for by primary care physicians (PCPs).

Also, there are 255,000 primary care physicians in the US. That’s compared to only approximately 8,000 nephrologists across the U.S.

Realistically, we’ll have to lean into PCPs to help with early on kidney care, given the insufficient number of nephrologists relative to the number of CKD patients. Agree?

Dr. Norris:

Yes, completely agree. The largest numbers of patients at risk are in the PCP pool.

That said, we need to make it as seamless and as easy as possible for PCPs because the largest number of patients at risk in gastroenterology, endocrinology and almost every other specialty, are also in the PCP pool.

So, every specialty is going to ‘the PCP’ and saying, ‘take care of my problem first’. And it becomes very difficult for the PCP to best assess and act, when he/she has to implement not only the primary care guidelines but that of other risk factors too.

That’s why it’s even more important to have community level interventions and why we must engage both PCPs and community partners in the development of actionable, clinical guidelines. As the initial ‘frontline,’ pharmacists and nurses should also share in care leadership, as they can better intervene/impact patients at the pre-diabetes stage, recommend life changes that might work (e.g., exercise, diet) and discuss therapeutic options. We shouldn’t underestimate the trust factor of a community voice alongside a clinical voice.

Of course, this level of change requires investment. We’ll need to support the PCPs, automate more of the healthcare journey and support health and wellness vs disease management.

Healthcare ecosystem CEOs may worry how these types of changes will impact quarterly earnings. We can and should value companies that are profitable, but not at the expense of a healthier society. If we invest in health, ‘the business’ side should work out. A healthier society leads to increased population productivity and results in increased profit, essentially a much larger piece of the pie. Unlike non-essential commodities, health should not be a domain for making unbridled profit at the expense of people.