We studied Primary Care based rheumatology clinics in Norfolk because of the unique model of specialist nurse practitioners working in Secondary Care and general practice.
This study demonstrates that a model of specialist nephrology NP led clinics with primary care clinicians is feasible and may improve risk factors for progression of CKD and cardiovascular death.
Few studies have examined the impact of these models on specialist referrals.
One solution is to move toward a model of specialists that regularly adapt to new work.
What our project adds to the literature is a model of specialists providing population-based care that identifies and risk stratifies the entire CKD population, directing nephrology resources to patients in need of them.
In this context, the German Medical Association's initiatives for a new, competence-based model statute of specialist training must be seen as an important step towards establishing such transparent and practice-oriented curricula [ 9].
Additional file 4 and Additional file 5 show the results of regression models for specialist services corresponding to equation 1 and Approach 2. Figure 2 shows estimates of relative per capital need for specialist services based on the two approaches.
The authors conclude that because of this interaction between two causal models, two types of specialist are needed: first, a traditional healer who removes the power of the witch, and second, a biomedic who eliminate the parasites [ 42].
