An assessment of the advantages and disadvantages of multidisciplinary models of care delivery in renal genetics clinics

The use of genetic testing in clinical practice has the potential to change the diagnostic landscape for patients with rare and inherited forms of kidney disease; multidisciplinary clinical models are proposed to support its adoption in clinical practice. However, there has been little investigation into the advantages and disadvantages of multidisciplinary models in renal genetics services. Additionally, the literature lacks information on the structures and workflows of renal multidisciplinary services which support the use of genetic medicine. Therefore, the aims of this thesis were: 1) to model the structure and workflows of multidisciplinary renal genetics clinics and 2) to investigate their advantages and disadvantages according to clinic team members. The research was conducted with clinical members of the renal genetics consortium, KidGen Collaborative. A literature review and an exploratory two-stage mixed methods design were employed, consisting of semi-structured interviews and an online survey. Process maps were used to define the clinical models and thematic coding and descriptive statistics were used to analyse the advantages and disadvantages. The most important advantages of the model to clinic team members were shared expertise, professional development and education and accurate communication across specialties. The perceived financial unsustainability of the model was the most prevalent concern to team members. The findings of this study are directly relevant to the KidGen Collaborative and other specialist clinical services seeking to implement genetic testing for the diagnosis of rare and inherited conditions.