NKF Spring Clinical Meetings to address complex issues in nephrology
Click Here to Manage Email Alerts
Editor’s note: Healio | Nephrology News & Issues interviewed Michelle Estrella, MD, MHS, a professor of medicine and the renal section chief at the San Francisco VA Medical Center, about her role as conference chairperson and highlights of the agenda for the National Kidney Foundation Spring Clinical Meetings, which take place May 14-18 in Long Beach, California. For more information and to register for the meeting, visit www.kidney.org/spring-clinical.
Healio | Nephrology News & Issues: The NKF Spring Clinical Meetings (SCM) cater to a multidisciplinary audience in nephrology. Why do you think that is important?
Michelle Estrella, MD, MHS: Kidney disease is complex and requires a team approach. A unique aspect of this year’s SCM is a greater integration of patients’ voices throughout the program. By assembling patients and professionals from various disciplines, such as nephrologists, nurses, pharmacists, dietitians, social workers, researchers and policymakers, the SCM provides a powerful platform for interdisciplinary exchange of knowledge and expertise and of innovative ideas and collaboration.
The emphasis on drawing a multidisciplinary audience also offers a unique opportunity for networking. By connecting professionals and patients from diverse backgrounds, the conference creates an environment for participants to establish one-on-one connections that last beyond the days of the conference and to have a dialogue with peers with differing perspectives.
The hope is these connections will accelerate both the adoption of evidence-based practices and the advancement of research in nephrology.
Healio | Nephrology News & Issues: The lead session at the meeting for physicians is about individualized, personal care. How can we improve the nephrologist-patient relationship and shared decision-making?
Michelle Estrella, MD, MHS: The short answer is we must “work smarter, not harder.” I believe that during the next several years, we’ll make huge strides toward the vision of individualized care. There are several reasons to be optimistic; for brevity sake, I’ll highlight two.
First, an increasing number of providers of various backgrounds — primary care, cardiology, endocrinology and nephrology — acknowledge that we cannot practice in silos and are advocating for holistic approaches that address the inherent complexity of patients with kidney disease. A collaborative approach across disciplines could enable the use of pooled resources and complementary expertise to innovate on how we deliver care to patients.
By implementing population health management tools and practice facilitation strategies, we can identify high-risk patients, prioritize interventions that incorporate an individual patient’s multiple conditions simultaneously and deploy the nephrology workforce more effectively. Such approaches could eventually lower the caseload of patients with advanced kidney disease.
Second, the recent advances in artificial intelligence represent a large opportunity for physicians and other providers to augment clinical decision-making and substantially lighten their administrative workload. AI technologies can enable providers to access or even integrate medical evidence and current guidelines at the point of care. There are also ways to utilize AI for preauthorizations, real-time charting and “in-box” management. By automating such administrative tasks, providers could spend more time on what matters to them the most — direct patient interactions, thereby strengthening the physician-patient relationship.
Healio | Nephrology News & Issues: There is a presentation at SCM on pharmacoequity. Can you explain how that relates to kidney care staff?
Michelle Estrella, MD, MHS: Setting aside health system considerations, each member of the kidney team can strive toward achieving pharmacoequity. First, prescribing providers can contextualize an individual patient’s treatment plan, such as discussing the potential financial implications of different treatment options with patients or identifying gaps in adherence due to financial constraints. Pharmacists and social workers can identify access barriers, such as formulary restrictions, insurance coverage limitations or high out-of-pocket costs, and help patients navigate these processes.
Social workers and case managers can also facilitate access to medications by connecting patients to community resources or assistance programs. When counseling patients, members of a kidney care team should account for language barriers, cultural values and health literacy; this effort could pay dividends in optimizing medication adherence and patient safety.
Lastly, a patient’s kidney care team can collaborate to address social determinants of health, such as housing instability, that influence a patient’s ability to adhere to treatments, and together, have the power to advocate for additional system-level resources to address pharmacoinequities within their practice.
Healio | Nephrology News & Issues: There is a debate planned on Kt/V and its value in home dialysis. Is it time for the nephrology world to move on from this calculation?
Michelle Estrella, MD, MHS: I am excited about this debate on Kt/V as I think it is an important discussion to have as a specialty. I’ll wait to attend this Wednesday morning session before definitively providing my perspective on whether we should abandon Kt/V altogether.
Kt/V is nice in that it is established, easily measurable and familiar, but it captures only one dimension affected by dialysis treatments, and dialysis intensification to increase Kt/V hasn’t necessarily translated to improved patient outcomes. Recognizing the complexity of patients on dialysis and dialysis therapy itself, we should consider broadening how we assess and define dialysis adequacy. Adequacy will likely need to be multidimensional and span not only laboratory measurements (eg, clearance of uremic toxins, stability of electrolytes) but also volume management and patient-related symptoms. Ultimately, the goals of achieving dialysis adequacy are to optimize patient outcomes and quality of life. Therefore, I imagine that adequacy will need to be tailored to individual patients, taking into account their comorbidities, quality of life and life priorities.
Healio | Nephrology News & Issues: There are sessions on burnout and staff shortages. What do we need to do to attract more nephrologists and other staff to this profession?
Michelle Estrella, MD, MHS: Burnout is a huge issue across the nephrology workforce. We need to be mission-oriented and convey the importance of this work in improving outcomes and quality of life for patients with kidney disease. To attract new talent to nephrology, we also need to highlight what makes nephrology special – the opportunity to work as a team, the ability to establish meaningful relationships with patients in the outpatient and inpatient settings, and the tremendous momentum in scientific discovery, therapeutic options and effective policies.
To retain providers in the nephrology profession, we should appreciate what each team member brings to the table and empower them to help improve patient care in their own way; building in mentorship and coaching — even if just peer-to-peer — can be powerful in this way.
Healio | Nephrology News & Issues: What do you hope is the take-home message from this year’s SCM ?
Michelle Estrella, MD, MHS: Excitement for the specialty: Excitement for the momentum at all fronts that nephrology is experiencing. There is an expanding number of specific therapies for kidney disease, fresh thinking of how we deliver kidney care, and ongoing policy and advocacy work to sustain this momentum.
Team mentality: The nephrology community comprises the most dedicated, smart, compassionate and hard-working individuals in medicine, and I hope that connections made at SCM will translate to long-lasting fruitful collaborations.
Empowerment: I hope each attendee feels empowered to take the knowledge they’ve gained at SCM and apply it to their day-to-day practice and share it within their communities of practice.
- For more information:
- Michelle Estrella, MD, MHS, can be reached at michelle.estrella@ucsf.edu.
Collapse
Read more about
Click Here to Manage Email Alerts