Clinical governance for elderly patients with renal insufficiency. Community care programs

From a clinical governance perspective, process management is essential because it allows attention to be focused on the health problems of the people affected by illness, creating care programs that arise out of a holistic vision. This is all the more true when the people involved have specific care needs, like the elderly and patients with chronic illnesses whose primary place of care is outside the hospital and who, in any case, require continuity and coordination of care. This group certainly includes elderly patients with chronic kidney disease, the management of which has significant effects on health care settings. The national and regional dialysis and transplant registers currently provide partial data on this phenomenon, but our information is incomplete. What we lack is an unambiguous, uniform care program which addresses itself to community care for the elderly with chronic kidney disease and which, above all, places the nephrologist in a leading role. The issue is to provide a suitable solution for this anomaly, so that by putting aside an anachronistic hospital-centered vision, the nephrologist can move out into the community and come into contact with the sorts of cases which currently remain outside his or her field of vision. It is to be hoped that the Italian Society of Nephrology will spearhead this initiative by becoming more aware of the structural and organizational changes that the Italian health system is currently undergoing.