{
  "abstract": "Objectives To highlight data on interventions aimed at enhancing referral patterns from primary care to nephrology.Design Systematic review and meta-analysis.Data sources MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science and PsycINFO.Eligibility criteria Studies reporting interventions aimed at decreasing referral volume, reducing wait times and/or increasing guideline-concordant referrals in adult patients with chronic kidney disease from primary care to specialist kidney care, from inception to 15 April 2024.Data extraction and synthesis Studies were subcategorised based on taxonomy of initiatives, type of intervention and single versus multi-faceted interventions. Our primary outcomes were changes to referral volume, wait times and proportion of guideline-concordant referrals. Data were pooled using a random effects model and a meta-analysis was conducted using pooled mean difference (MD) and OR.Results 20 studies used single and 13 used more than one intervention. Overall, interventions resulted in an increase in total referrals (MD: 19 referrals per month, 95% CI 7 to 30; I 2=98%; p<0.001) and a non-significant decrease in the proportion of guideline-concordant referrals (OR: 0.32, 95% CI 0.09 to 1.16; I2=100%; p=0.08). These effects were consistent when stratified by single versus multi-faceted interventions, and by taxonomy of interventions. Interventions categorised as financial, regulatory or legislative incentives (n=2) led to an increase in guideline-concordant referrals (OR: 1.15, 95% CI 1.02 to 1.29; I2: 0%; p=0.02). Organisational changes showed a non-significant reduction in wait time of 24 days (95% CI −64 to 15, I2=99%; p=0.23) but tended to decrease guideline concordant referrals (OR: 0.17, 95% CI 0.03 to 0.86; I2: 100%; p=0.03).Conclusion Organisational changes decreased wait times. Overall, interventions increased referral volume and decreased guideline-concordant referrals. The data have implications for designing programmes to improve primary care-nephrology interface in kidney disease management.",
  "authors": [
    {
      "affiliations": [
        "Medicine, University of Calgary, Calgary, Alberta, Canada",
        "Medicine, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Anukul Ghimire"
    },
    {
      "affiliations": [
        "Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Vinash Kumar Hariramani"
    },
    {
      "affiliations": [
        "Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Abdullah Abdulrahman"
    },
    {
      "affiliations": [
        "Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Feng Ye"
    },
    {
      "affiliations": [
        "John W. Scott Library, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Janice Y Kung"
    },
    {
      "affiliations": [
        "Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Somkanya Tungsanga"
    },
    {
      "affiliations": [
        "University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Alan Grill"
    },
    {
      "affiliations": [
        "University of Manitoba, Winnipeg, Manitoba, Canada"
      ],
      "name": "Alexander Singer"
    },
    {
      "affiliations": [
        "Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada"
      ],
      "name": "Ayub Akbari"
    },
    {
      "affiliations": [
        "Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Branko Braam"
    },
    {
      "affiliations": [
        "Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "David Collister"
    },
    {
      "affiliations": [
        "Medicine, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Elena Qirjazi"
    },
    {
      "affiliations": [
        "Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Kailash Jindal"
    },
    {
      "affiliations": [
        "Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Mark Courtney"
    },
    {
      "affiliations": [
        "Medicine, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Matthew Cooper"
    },
    {
      "affiliations": [
        "Medicine, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Matthew James"
    },
    {
      "affiliations": [
        "Medicine, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Marcello Tonelli"
    },
    {
      "affiliations": [
        "Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Nikhil Shah"
    },
    {
      "affiliations": [
        "Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Paul E Ronksley"
    },
    {
      "affiliations": [
        "Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Sabin Shurraw"
    },
    {
      "affiliations": [
        "McMaster University, Hamilton, Ontario, Canada"
      ],
      "name": "K Scott Brimble"
    },
    {
      "affiliations": [
        "Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Scott Klarenbach"
    },
    {
      "affiliations": [
        "Medicine, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Sophia Chou"
    },
    {
      "affiliations": [
        "Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Soroush Shojai"
    },
    {
      "affiliations": [
        "Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Vinay Deved"
    },
    {
      "affiliations": [
        "Family Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Andrew Wong"
    },
    {
      "affiliations": [
        "Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Deenaz Zaidi"
    },
    {
      "affiliations": [
        "Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Ikechi Okpechi"
    },
    {
      "affiliations": [
        "Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Aminu K Bello"
    }
  ],
  "title": "Initiatives to enhance referral patterns from primary care to specialist kidney care:a systematic review and meta-analysis",
  "uid": "f8947d58-3f11-524e-8ae7-378012f29c55"
}