Nephrologists have been calling for the introduction of coordinated nephrological care in Poland for years. Today, kidney patients are cared for by general practitioners, at nephrology clinics, other specialist clinics, by specialists in hospital wards and at transplantation and diagnostic centers. From the payer's perspective, the aim of integrated care is to ensure finances are used as efficiently as possible. From the point of view of a patient lost in the system, coordinated care helps improve their health. In your opinion, what could be the main benefits of coordinating nephrological care for countries in a similar situation as Poland?
Nephrology is a branch of medicine that intersects with many other specializations. Many of the chronic diseases that patients suffer from lead to kidney damage and thus to chronic kidney disease (CKD). Also, kidney damage itself is the cause of very serious systemic diseases that affect the patient's health and require treatment. CKD patients also often suffer from hypertension, diabetes or obesity. A nephrologist is therefore a very special physician who must have knowledge and experience in many vast fields of medicine.
The experience gained by our company and the observations conducted for many years prove that well-coordinated care for patients at risk of developing chronic kidney disease may delay the progression of this disease and, subsequently, the need for renal replacement therapy for many years. Transferring patients more rapidly from primary care outpatient clinics to coordinated nephrology centers would certainly reduce the overall cost of treating CKD patients and allow patients to live longer and enjoy a better quality of life.
How does coordinated care for kidney patients work in countries where Fresenius Medical Care is present? What can we learn from other countries?
The introduction of a coordinated nephrological care system is certainly a very difficult and labor-intensive undertaking for health care systems in any country. It is difficult for me to give an example of a specific place in the world where this kind of system works perfectly. Every system introduced in any country, not only in the field of health care, needs improvements based on lessons learned and mistakes made. Coordinated nephrological care is an area that still requires commitment, financial investment, work and better organization. There is need for improvement in many countries that I am involved with at Fresenius Medical Care.
However, we have observed that the best effects of coordinated nephrological care were achieved in countries that introduced population care. In these systems, renal diseases are diagnosed at an early stage using screening tests and treated in a single facility, where the patient has access to nephrological consultation throughout the entire disease. In these countries, the introduction of this system slows down the development of CKD and improves the results of treatment.
Coordination of patient care should take place in two stages: The first stage of the patient's path includes the time it takes to diagnose the disease, initial nephrological consultations and regular patient care. The second stage of consolidation in the care of a patient suffering from CKD includes activities related to renal replacement therapy. A patient requiring dialysis usually attends a dialysis clinic three times a week. At this point, they meet with medical staff - a nephrologist and a dialysis nurse who has a clear understanding of their medical history. A dialysis clinic should, however, be part of a facility that provides broader coordinated patient care. The patient should have constant access to doctors specializing in different disciplines.
When talking about patients who require renal replacement therapy, we should bear in mind that these people often have many diseases. The mere necessity of staying in a dialysis clinic is a great effort for them. Waiting in queues for other specialists such as diabetologists, internists or cardiologists in different establishments is a barrier for them, which very often deters them from having other diseases treated. This then results in a very difficult situation where patients with CKD, who are very well looked after nephrologically and regularly dialyzed, are unable to go on a transplantation waiting list because they have other untreated diseases. This situation could ultimately be fatal.
The goal for our company is to ensure the patient is in the best possible state of health until transplantation. We also make sure that our patients' health allows them to be permanently on transplant lists, so that when a kidney becomes available for them, they are ready for organ transplantation. That is why we run educational and social campaigns in which we talk about the need for coordinated care for kidney patients. This kind of system is a great opportunity for patients and is something many of them have been waiting for a very long time. It makes everyday life easier.
What countries can be a role model when it comes to the comprehensive nature of nephrological care?
A coordinated nephrological care system works in many countries in Europe and around the world. It would certainly come as no surprise to find out that Nordic countries, which have relatively high financial resources to spend on health care, are good examples here. However, I would like to draw attention to another country where coordinated care for nephrological patients works very efficiently. This is Portugal. In Portugal, the system of coordinated care for patients undergoing dialysis is at a very high level, even though it has only been in operation for a few years. Looking at the system today, we can see that it has reduced the total cost of care for a group of patients with CKD. In addition, the patients' life expectancy and quality of life has significantly improved based on the number of hospitalizations and the duration of hospital stays.
In Poland and across the globe, Fresenius Medical Care offers treatments in dialysis centers, nephrology wards and outpatient clinics. According to data from a national consulting company in the field of nephrology, 95% of kidney patients in Poland are not aware of their disease. How can we change these terrifying statistics and who should take responsibility for preventing and slowing the progression of chronic kidney disease?
I believe different authorities and stakeholder groups can positively shape nephrological education in Poland, as there is currently still a lack of action in this area in the country. The nephrological environment and companies working in a similar area to us can act and provide this kind of education. We need it for the patients themselves and, most importantly, for general practitioners and other healthcare professionals. CKD is a silent disease. The initial stage is asymptomatic for many, which is why it is often overlooked by patients and doctors alike. To improve the statistics you mentioned, we must step up to the challenge of education and ensure that the first nephrological consultation a patient has is provided is of the highest level of quality.
Fresenius Medical Care attaches great importance to collecting, measuring and benchmarking patient-relevant data. More than 800 dialysis clinics, mostly in EMEA countries, use the common clinical management system European Clinical Database (EuCliD). How does this IT tool use standards to more effectively manage and optimize treatment in individual dialysis centers?
The clinical management system EuCliD is one of the most important tools in the clinical workflows of our company. In medicine, standardizing procedures is very important. Identifying and establishing specific actions during the course of diagnostics and treatment allows us to harmonize care delivery standards across all clinics. Of course, this does not mean that every patient should be treated in the same way. However, this large database of information about various groups of patients allows doctors to more effectively select individual therapy for different patients.
Our system allows the medical data of over 100,000 dialyzed and treated patients in our network to be collected anonymously and in a standardized way. EuCliD gives us the opportunity to compare the data on therapy methods and their results. Our database simultaneously receives information from different places around the world, giving us an amazing opportunity to compare results and focus on those treatments and procedures that lead to better therapeutic outcomes. Thanks to our system, the doctors who work with us can exchange their experiences and use this information to make better therapeutic decisions.
In Poland, almost 400 doctors work in our dialysis network and are connected to each other. As a company, we make sure that the training organized by us for specialists has a very high and similar standard around the world. It is very important to us that the doctors who work with us feel like they are part of a community. Our central Medical Office is a place where they can always ask to compare therapy methods or find therapeutic precedents with EuCliD.
The company participates in national and international clinical trials, willingly shares its experiences and successes. How does this transparency affect employees and patients?
In a very positive way. Many of my colleagues in different countries point out that, as a company, we are faithful to the mission of our profession – we examine, analyze, publish and share medical data. Publishing and contributing to the development of medical knowledge is also an important part of our mission. The goal of our company is to present valuable medical data that reflects the quality of our work and commitment. It is extremely important for us that we can utilize our experience and train doctors to a very high level.
Patients also benefit from our experience. A large proportion of patients in Europe are directly under our care or are being dialyzed using our medical devices. It is also part of our mission to provide patients with a comfortable life until transplantation. That's why we all channel so much effort, commitment and dedication into our work. We are all aware that we are responsible for the patients we care for.
Value-based healthcare is nowadays considered to be the best way to improve treatment outcomes while at the same time preventing costs from rising. What in your experience is the key to value-based medicine in nephrology?
I think the most important elements are coordinating treatment and measuring treatment results in a comparable way. These are two factors that convinced me as a doctor when I first came across the Fresenius Medical Care model. I was also very positively surprised by the unprecedented consistency in documenting medical results and the great openness in publishing and comparing them. Today, we can see that the experience we have gathered allows us to create an efficient strategy of coordinated nephrological care that leads to better therapy results and enables us to extend the life of patients and improve their quality of life.