In other words, theoretically for this group, decision-making discussions could have taken place opportunistically during traditionally-arranged, episodic clinic visits (as opposed to clinic visits scheduled specifically for the purpose of carrying out such discussions).
The current medical model of episodic nephrologist office visits is not well matched to the needs of the late-stage CKD, these patients are complex and require bridging care between office visits to optimize medical conditions, prevent complications, facilitate care plan progress and strengthen patient education and self-management.
An interprofessional team-based method of multiple chronic disease management in this patient population may be a more optimal approach, as individuals in the highest quartile of events are poorly served by episodic care, short visit times, and strategies of managing complexity that yield more utilization.
Most participants took an opportunistic approach to preventative health care, providing child health surveillance focused on growth, hearing, vision and speech when a child was brought in for a scheduled immunisation visit, an episodic illness or when brought in by a "motivated mother".
In Manitoba, ambulatory care (non-emergency, condition-specific single visit or episodic care provided on an outpatient basis in support of primary care) is offered by primary care physicians, nurse practitioners and specialist physicians, and patients are free to seek ambulatory care from any provider of their choosing.
One barrier, the episodic nature of nephrologist office visits may leave the late-stage CKD patient exposed between visits because there are so many medical events, care processes that need to be achieved, medication changes and other physician visits with changes in treatment.
We hypothesize that when it comes to routine home visits for brief, episodic illnesses, the home visiting trend may be as Aylin suggests.
Such visits are usually episodic and cease when the immediate symptoms are relieved.
They have the potential to empower patients, support chronic disease self-management, and move beyond care based on episodic, in-person, and often discontinuous visits (2, 3).
