Outpatient Interventions for Managing Acute Complications of Chronic Diseases: A Scoping Review and Implications for Patients With CKD

Comparison of Acute Health Care Utilization Between Patients Receiving In-Center Hemodialysis and the General Population: A Population-Based Matched Cohort Study From Ontario, Canada

Background

Patients receiving maintenance hemodialysis have multiple comorbidities and are at high risk of presenting to the hospital. However, the incidence and cost of acute health care utilization in the in-center hemodialysis population and how this compares with other populations is poorly understood.

Objective

To determine the rate, pattern, and cost of emergency department visits and hospitalizations in patients receiving in-center hemodialysis compared with a matched general population.

Design

Population-based matched cohort study.

Setting

We used linked administrative health care databases from Ontario, Canada.

Patients

We included 25 379 patients (incident and prevalent) receiving in-center hemodialysis between January 1, 2010, and December 31, 2018. Patients were matched on birth date (±2 years), sex, and cohort entry date using a 1:4 ratio to 101 516 individuals from the general population.

Measurements

Our primary outcomes were emergency department visits (allowing for multiple visits per individual) and hospital admissions from the emergency department. We also assessed all-cause hospitalizations, all-cause readmissions within 30 days of discharge from the original hospitalization, length of stay for hospital admissions (including multiple visits per individual), and the financial cost of these admissions.

Methods

We presented the rate, percentage, median (25th, 75th percentiles), and incidence rate per 1000 person-years for emergency department visits and hospitalizations. Individual-level health care costs for emergency department visits and all-cause hospitalization were estimated using resource intensity weights multiplied by the cost per weighted case.

Results

Patients receiving in-center hemodialysis had substantially more comorbidities (eg, diabetes) than the matched general population. Eighty percent (n = 20 309) of patients receiving in-center hemodialysis had at least 1 emergency department visit compared with 56% (n = 56 452) of individuals in the matched general population, over a median follow-up of 1.8 years (25th, 75th percentiles: 0.7, 3.6) and 5.2 (2.5, 8.4) years, respectively. The incidence rate of emergency department visits, allowing for multiple visits per individual, was 2274 per 1000 person-years (95% confidence interval [CI]: 2263, 2286) for patients receiving in-center hemodialysis, which was almost 5 times as high as the matched general population (471 per 1000 person-years; 95% CI: 469, 473). The rate of hospital admissions from the emergency department and the rate of all-cause hospital admissions in the in-center hemodialysis population was more than 7 times as high as the matched general population (hospital admissions from the emergency department: 786 vs 101 per 1000 person-years; all-cause hospital admissions: 1056 vs 139 per 1000 person-years). The median number of all-cause hospitalization days per patient year was 4.0 (0, 16.5) in the in-center hemodialysis population compared with 0 (0, 0.5) in the matched general population. The cost per patient-year for emergency department visits in the in-center hemodialysis population was approximately 5.5 times as high as the matched general population while the cost of hospitalizations in the in-center hemodialysis population was approximately 11 times as high as the matched general population (emergency department visits: CAN$ 1153 vs CAN$ 209; hospitalizations: CAN$ 21 151 vs CAN$ 1873 [all costs in 2023 CAN$]).

Limitations

External generalizability and we could not determine whether emergency department visits and hospitalizations were preventable.

Conclusions

Patients receiving in-center hemodialysis have high acute health care utilization. These results improve our understanding of the burden of disease and the associated costs in the in-center hemodialysis population, highlight the need to improve acute outcomes, and can aid health care capacity planning. Additional research is needed to address the risk of hospitalization after controlling for patient comorbidities.

Trial registration

This is not applicable as this is a population-based matched cohort study and not a clinical trial.

Effects of a Health Literacy Education Program on Mental Health and Renal Function in Patients With Chronic Kidney Disease: A Randomized Controlled Trial

BACKGROUND

Chronic kidney disease (CKD) refers to permanent damage to the kidneys that occurs gradually over time. Further progression may be preventable depending on its stage.

PURPOSE

This study was developed to evaluate the effect of a health literacy education program (HLEP) on mental health and renal functioning in patients with CKD.

METHODS

A single-blind, randomized controlled trial study was conducted. Data were collected from March 25 to December 18, 2021. Participants were randomly assigned to either the experimental group (n = 42), which received multidisciplinary care and HLEP, or the control group (n = 42), which received multidisciplinary care only. Data were collected at baseline (T1), Month 3 (T2), and Month 6 (T3), and the data included patient characteristics, estimated glomerular filtration rate, and responses to the Mandarin Multidimensional Health Literacy Questionnaire and Beck Depression Inventory.

RESULTS

After 6 months of the HLEP intervention, the results of generalized estimating equations analysis showed that, compared with the control group, the experimental group had significantly higher health literacy at Month 3 (β = -3.37, 95% CI [-5.68, -1.06]), significantly improved depression at Month 3 (β = -2.24, 95% CI [-4.11, -0.37]) and Month 6 (β = -4.36, 95% CI [-6.60, -2.12]), and a significantly higher estimated glomerular filtration rate at Month 6 (β = 5.87, 95% CI [1.35, 10.38]).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings of this study may provide a reference for healthcare providers to educate patients with Stage 3-4 CKD using the HLEP. Positive effects on health literacy, depression, and renal function in patients with Stage 3-4 CKD were observed in the short term. Findings from this study may facilitate the implementation of multidisciplinary and nurse-led strategies in primary care to reinforce patients' health literacy, self-care ability, and adjustment to CKD as well as delay disease progression.

The impact of psychological resilience on chronic patients' depression during the dynamic Zero-COVID policy: the mediating role of stigma and the moderating role of sleep quality

OBJECTIVE

Chronic patients are experiencing depression caused by themselves or the surrounding environment, how to cope with the change of mentality and adjust the psychological stress response, especially under the background of the current dynamic Zero-COVID policy in China, is a problem worth further discussion. The researchers constructed a mediating regulation model to test the influence of psychological resilience on depression of chronic patients during dynamic Zero-COVID, as well as the mediating role of stigma and the moderating role of sleep.

METHOD

From October 2021 to February 2022, this study used a multi-stage sampling method and random number table method to collect data in the Shang Cheng District of Hangzhou City, Zhejiang Province. Firstly, the Second Affiliated Hospital of the Zhejiang University School of Medicine, a third-class hospital was randomly selected from the Shang Cheng District. Secondly, three departments were strategically selected from this hospital: endocrinology, dermatology, and traditional Chinese medicine. Thirdly, survey points were set up in each department, and chronic patients were strategically selected for questionnaire surveys. Finally, a face-to-face survey was conducted on 398 chronic patients who met the criteria for inclusion. In addition, chronic medical illness burden was assessed using the Cumulative Illness Rating Scale-Geriatrics (CIRS-G), psychological resilience was measured by the Conner-Davidson Resilience Scale (CD-RISC), stigma was measured by the Stigma Scale for Chronic Illness (SSCI), sleep was measured by the Pittsburgh Sleep Quality Index(PSQI) and depression was estimated by the Patient Health Questionaire-9(PHQ-9). SPSS (version 25.0) and PROCESS (version 4.0) were used for correlation analysis, mediation analysis, and mediated moderation analysis.

RESULTS

Psychological resilience was negatively correlated with depression, stigma, and sleep. Depression was positively correlated with stigma and sleep. Stigma and sleep were positively correlated; Stigma played a mediating role in the relationship between psychological resilience and depression; Sleep moderated the first half of the pathway "psychological resilience [Formula: see text] stigma [Formula: see text] depression".

CONCLUSION

Psychological resilience affected depression directly and indirectly through stigma. At the same time, sleep played a moderating role between psychological resilience and depression. The correlation between psychological resilience and stigma was stronger when levels of sleep levels were higher.

Individuals' Awareness of and Willingness to Accept Hospital-at-Home Services and Related Factors: A Cross-Sectional Study

Introduction

Hospital-at-home (HaH) services have become increasingly popular. However, the experience of HaH implementation in Asia is inadequate. Therefore, the purpose of this study was to investigate individuals' willingness to accept HaH services and the potential related factors.

Methods

The researchers visited households to select appropriate participants. An online questionnaire survey was conducted among the inhabitants of selected communities. An individual's awareness, willingness to accept HaH services, and demands such as ideal service providers and more detailed information to accept HaH care were investigated. The outcome measure was the willingness to accept HaH services. Chi-square tests and logistic regression models were used to analyze the factors.

Results

A total of 622 subjects participated in this study. The findings indicate that 55.9% of the participants were not aware of HaH services, while most of the subjects (88.4%) were willing to accept them. Regression models indicated that having health insurance (OR = 2.170, 95% CI: 1.003–4.697), an awareness of the necessity of HaH services (OR = 4.721, 95% CI: 2.471–9.019), very much hoping staff from central hospitals would be service providers (OR = 20.299, 95% CI: 5.718–72.068), and somewhat hoping that staff from central hospitals would be service providers (OR = 9.139, 95% CI: 2.714–30.775) were the factors associated with a greater willingness to accept HaH services.

Conclusion

The study indicates that compared to the awareness of HaH care, residents had a greater willingness to accept such care. The willingness to utilize HaH services among individuals was associated with enabling factors, predisposing factors, and HaH-related demand factors.