Background: Advances in transplantation procedures, immunosuppressive agents, and the management of comorbid conditions have led to better outcomes in kidney transplant recipients (KTR). The subsequent rise in the number of KTR and the duration of post-transplant follow-up care places a strain on the limited resources of specialized transplant centres. Thus, innovative models of long-term care for KTR is needed to alleviate this strain and improve the capacity of these centres. Shared-care practices, integrating community nephrologists with the transplant team, is an approach to improve the efficiency and quality of care provided to stable KTR. A literature review was conducted to investigate existing shared-care models in KTR while a scoping review was conducted to further explore shared care models in chronic disease management.
Methods: For the primary literature review, Medline and CINAHL were searched with keywords including “kidney transplant”, “long-term”, “community”, and “care”. For the scoping review, Medline was searched with terms including “diabetes”, “heart failure”, “shared-care”, “long-term”, and “care”. We included peer-reviewed articles and abstracts published in English from 1970 to 2016. Two reviewers independently assessed and extracted data from included articles.
Results: After screening 1053 articles for the primary search, 13 were found eligible and included in the review. The articles from the primary search separated into two major themes: articles explaining shared care protocols for the long-term management of KTR and articles summarizing clinical management strategies after transplantation. Four articles described specific shared-care models with community nephrologists by suggesting a timeline for transfer and follow-up, outlining guidelines for communication, and identifying possible setbacks to implementation. Due to limited information obtained on implementation and evaluation of shared-care models, we expanded our review to consider models used in the management of heart failure and diabetes. Some important factors in the implementation of shared-care for these complex conditions included the role of a specialist nurse to facilitate coordination between centres as well as standardized clinical and referral guidelines. Shared-care practices generally resulted in improvements in information exchange and received positive responses from patients and healthcare staff. Patient health outcomes were found to be at least comparable to (and sometimes better than) less collaborative models.
Conclusion: While a standardized shared-care model for the management of stable KTR has not yet been established, sharing of patient care responsibilities between the transplant center and community nephrologists optimizes access to post-transplant care, may improve the quality of care, and reduces the burden on transplant centres.