There is a serious mis-match in the perceptions of patients, GPs and secondary care staff when it comes to identifying individual roles in a shared care approach for renal transplant patients new research has found. The research, launched today at the British Pharmaceutical Conference, was carried out jointly by the Manchester School of Pharmacy and Pharmaceutical Sciences and Manchester Royal Infirmary.
Shared care is employed widely for the care of renal patients after their transplant. Immunosuppressive therapy is complex, expensive and requires close monitoring. Research suggests that shared care is not always carried out effectively, leading to inferior care for patients and poorer health outcomes.1,2
In the Manchester study, patients, renal unit staff and GPs were asked about their views on post-renal transplant care to assess whether care is perceived to be sub-optimal, and reasons for those perceptions. The key results are summarised:
The patient's role:
Whilst patients felt that they had an active role in decision-making, GPs and renal unit staff felt that the patient played a passive role in the management of their care.
The GP's role:
Many GPs felt that patients relied on them as someone they knew well, and trusted them more than the renal unit. However, patients perceived GPs as having little expertise in renal transplantation and immunosuppressants, with minimal input other than prescribing.
Whilst GPs saw their role in shared care as simply prescribing and monitoring for treatment prescribed by the renal unit, renal unit staff believed GPs' roles included monitoring drug therapy, identifying adverse drug reactions, encouraging patients to take their medicines effectively and lifestyle advice.
Renal unit's role:
This was one of the few areas for agreement. All groups perceived the renal unit's role to be major, including acute post transplant care, re-admissions, monitoring and medication changes.
Pharmacist Dr Rachel Elliott, Clinical Senior Lecturer at the School of Pharmacy, University of Manchester, said that these exposed misperceptions could seriously damage the recovery and long-term health of renal patients. "The NHS is promoting shared care as the optimum care for patients. However, the benefits of shared care will only be seen if understanding of responsibilities improves between hospital staff, GPs and patients," she said.
Dr Elliott said that it was extremely worrying that health professionals expect patients to play such a passive role in the management of their own care. She said, "The research shows that patients are not content to have so little involvement in decisions about their care and want to take more responsibility."
Dr Elliott concluded, "Patients rely heavily on the renal unit and are reluctant to trust their GP or local hospital to manage their care. GPs need more support if they are to have a bigger role in shared care, and patients need encouragement to utilise their GP and local hospital more effectively."
