| Care model | We are becoming more consistent because we have gone to a shared clinic model. I suspect we have become more consistent. I don't have any data to prove that. We talk about it more, that we are going to keep them on "x" dose. And the nurses are consistent, with the 2 nurses. (Nephrologist 1, site G) |
| The parents find that very hard, that they see a different person every time, sometimes. They find that a major challenge. There used to be a doctor-based clinic. (Nurse 2, site G) |
| Shared clinics. So, yes, there is good advantage and yes, we do have a good group and [for the] most part they all do the same thing. The parents really, if it's somebody that is chronic and has an acute episode, they would prefer seeing their regular physician than seeing somebody else. (Nurse 2, site H) |
| I think the other thing to highlight is that we do have a shared clinic, so that these nephrotics, right when they are coming to see us for follow-up, it may be Dr. [name], it may be Dr. [name], it may be me. So at least on Fridays, it is discussion. We have to come to a consensus in a way, because whoever is going to see that person in clinic has to be saying the same thing. So it works out well, those clinic rounds, in conjunction with how we run the clinic. (Nephrologist 6, site H) |
| Structures and resources | Cost might be an issue because provincially it varies from place to place. If somebody said to us "Everyone is going to [mycophenolate mofetil]," we would be, like, "Now you are dreaming." Or "Everybody needs rituximab." We just couldn't do all of those things. (Nurse 1, site B) |
| If we are talking about workload, what affects workload is the absence of dieticians and social workers. (Nurse 1, site B) |
| One of the things that I think was a barrier, and it's recently been solved, is the cost and availability of the medications used to treat nephrotic syndrome. You know, some of them can be very expensive for families. (Nephrologist 2, site D) |
| Communication and collaboration | I'd have to say centre-specific. I trained in [site G], so you know, I know what their protocol was - well, 13 years ago, I don't know what they're currently using now. But I don't think there's any - I have no idea what [site J] - you probably know what [site H] uses, because you worked there. But I have no idea what other centres use. (Nephrologist 2, site I) |
| I guess I would say, if we read [investigator's] paper, we know there is variability. I don't know if I could tell you what centre does what. (Nephrologist 1, site G) |
| We don't care so much what everybody else is doing to tell you the truth, because no one is really that convinced that they're …(Nephrologist 1, site C)Because there's no solid evidence in anything, so … (Nephrologist 4, site C) |
| Yeah, reading, stuff like that. Actually, to be honest, I couldn't tell you exactly how, yeah, how other centres treat and how they decide to treat. We never had that communication, so it's like - it's funny because nephrotic syndrome is probably one of the more common diseases we see in pediatrics and pediatric nephrology. And I think the assumption is that where you train is essentially how you're going to practise. (Nephrologist 1, site J) |
| I think that our communication within the physicians is enhanced greatly by having a dedicated nurse. … I think that's a great enhancement to the communication between doctors and I think that not having a dedicated nurse for nephrotic syndrome would be the worst thing that could happen to us, if we did not have that. (Nephrologist 3, site E) |