Telenephrology Implementation.

The incidence of Chronic Kidney Disease in primary care is rising. A referral to a nephrologist is a burden for the patient and is expensive. With the aid of specialist's knowledge, a general practitioner could provide better care and prevent referrals. Telenephrology is a webbased technique, which facilitates general practitioners to consult a nephrologist. Data from the electronic patient file are extracted and imported to an internet platform. The general practitioner adds his of her question to the nephrologist. The nephrologist answers and the answer will appear in the electronic patient file. In a cluster randomised trial 38 Dutch general (group)practices will be randomised for either use of Telenephrology or usual care (phone) to consult a nephrologist. They will be given a list of patients with CKD, in which a nephrologist-consultation is advisable according to the Dutch CKD standard (approx 36 patients per group-practice).

After a year, the number of nephrology referrals and consultations and data on blood pressure and metabolic parameters will be measured.

In the care for patients with Chronic kidney Disease, practices that use Telenephrology will refer less to nephrologists and consult more than practices that do not use Telenephrology. Telenephrology is a webbased technique, which facilitates general practitioners to consult a nephrologist; data from the electronic patient file are extracted and imported to an internet platform. The general practitioner adds his of her question to the nephrologist. The nephrologist answers and the answer will appear in the electronic patient file.

After one year the number of referrals and consultations will be measured. Blood pressure and laboratory parameters will be extracted from the electronic patient file.

1. Intervention practices use Telenephrology to consult a nephrologist;

2. Control practices consult in their usual way (by phone).