Outpatient Clinic

Information for patients

During the care process, personal goals are set in consultation with your GP and kidney specialist, which guide the management of your kidney disease. The aim is to achieve these goals to the best of you ability and slowing down the progression of your kidney disease.

Advantages

By participating in this care pathway, you will enjoy a number of benefits that will prevent the deterioration of your kidney function:

• Your consultations with the general practitioner (in his office) and nephrologist are fully reimbursed within the framework of this care programme
• You will receive an allowance for the purchase of a blood pressure meter
• Certificates are no longer required for certain medications
• Depending on the severity of your kidney failure (renal insufficiency), you will be entitled to a number of consultations with the dietician

Useful link: www.zorgtraject.be

“Care pathway” Brochure (source: Onafhankelijke Ziekenfondsen)

Information for general practitioner

Care pathways aim to organise an optimum cooperation between patients with a chronic illness, their general practitioner, specialist and other health professionals for a qualitative follow-up of the patient.

A care pathway starts from a cooperation between 3 parties, i.e. patient, general practitioner and specialist. The programme starts after a “care contract” is signed by these 3 parties and runs for 4 years.

The objectives of a care pathway are:

• Organising, coordinating and planning the approach, treatment and follow-up of patients according to their specific situation.
• Stimulating dialogue with patients so that they can better understand their illness and the follow-up.
• Optimising the quality of care.

Inclusion criteria for the chronic renal insufficiency care pathway:

• An estimated GFR <45ml/min/1.73m2 according to the simplified MDRD formula
• confirmed a second time after at least 3 months and/or
• A proteinuria > 1g per day confirmed a second time after at least 3 months
• Aged over 18
• Not on dialysis and not having undergone a kidney transplant
• Capable of outpatient follow-up

Other conditions:

• Signing of the care pathway contract
• GMD (general medical file) with GP who signs the contract (at the latest within a year of the start of the care pathway)
• At least 2 consultations with GP and 1 consultation with specialist per year

Useful link