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Rahman T, Ahmed S, Kabir MR, Akhtaruzzaman M, Mitali EJ, Rashid HU, Daud ZM, Khor BH, Kaur D, Khosla P. Provision of renal-specific nutrition knowledge for changing dietary practice in Bangladeshi hemodialysis patients. PEC INNOVATION 2022; 1:100028. [PMID: 37213733 PMCID: PMC10194273 DOI: 10.1016/j.pecinn.2022.100028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 05/23/2023]
Abstract
Objective Studies show that provision of nutrition knowledge help renal patients make informed food choices. This study aimed to evaluate the impact of nutrition knowledge for changing dietary practice among Bangladeshi dialysis patients. Methods Following development of a renal-specific nutrition booklet, a pilot study was conducted among 50 hemodialysis patients from a single dialysis setting. Demographic, anthropometric, clinical, biochemical, dietary data, and a 10-item MCQ on renal-specific nutrition information were collected before and 3 months after the provision of the booklet. Results 52% of the participants were male, 54% had twice weekly dialysis, age 53 ± 12 years, and dialysis vintage was 46 ± 25 months. Serum potassium and phosphorous, dietary potassium, phosphorous, and phosphorous to protein ratio were significantly reduced after the provision of the booklet. Additionally, patients consuming >3 meals/day increased to 66% while adherence to renal-specific cooking method and vegetable preference were significantly increased to 70% and 62%, respectively. Conclusion Provision of knowledge via renal-specific nutrition booklet was able to improve patients' dietary practice and enhance their dietary adherence to renal specific recommendations. Innovation The booklet was developed using locally available food items in local language and was found beneficial in low-resource settings where overall health care facilities, including nutrition support are limited.
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Affiliation(s)
- Tanjina Rahman
- Institute of Nutrition and Food Science, University of Dhaka, Bangladesh
- Dept. of Nutrition and Food Science, Wayne State University, Detroit, MI, USA
| | - Shakil Ahmed
- Dept. of Food Technology and Nutrition Science, Noakhali Science and Technology University, Sonapur-3814, Bangladesh
| | - Md Ruhul Kabir
- Dept. of Food Technology and Nutrition Science, Noakhali Science and Technology University, Sonapur-3814, Bangladesh
| | - M Akhtaruzzaman
- Institute of Nutrition and Food Science, University of Dhaka, Bangladesh
| | | | - Harun-Ur Rashid
- Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - ZulfitriAzuan Mat Daud
- Dept. of Dietetics, Faculty Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia
| | - Ban-Hock Khor
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Malaysia
| | - Deepinder Kaur
- Dept. of Nutrition and Food Science, Wayne State University, Detroit, MI, USA
| | - Pramod Khosla
- Dept. of Nutrition and Food Science, Wayne State University, Detroit, MI, USA
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Lee MC, Wu SFV, Lu KC, Wang WH, Chen YY, Tai CY. Effect of Patient-Centered Self-Management Program on Blood Pressure, Renal Function Control, and the Quality of Life of Patients With Hypertensive Nephropathy: A Longitudinal Randomized Controlled Trial. Biol Res Nurs 2021; 24:216-225. [PMID: 34964363 DOI: 10.1177/10998004211061877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This longitudinal study with a randomized controlled trial evaluated the long-term effectiveness of the patient-centered self-management intervention program on the control of blood pressure and renal function, as well as the quality of life of patients with hypertensive nephropathy. The control group (n = 38) received usual care while the experimental group (n = 38) participated in a patient-centered self-management program. After the pre-test, the intervention was performed with the experimental group once a week for a total of 4 weeks. Then, the post-test was performed 1, 3, and 6 months later. A questionnaire was used to collect the demographic data and disease characteristics, laboratory data, and quality of life scale. This study tracked three time points (i.e., 1, 3, and 6 months) after the intervention and found that the experimental group achieved significant results in controlling systolic blood pressure (p < 0.001), diastolic blood pressure (p = 0.007), and eGFR (p = 0.013). Significant results were achieved in the overall quality of life (p < 0.001) and the quality of life in the physical (PHC; p < 0.001) and mental health components (MHC; p < 0.001). Furthermore, the effects in the experimental group lasted for as long as 6 months and were better than those in the control group. Moreover, this program can provide nursing staff with a reference different from traditional health education methods.
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Affiliation(s)
- Mei-Chen Lee
- School of Nursing, 38028National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shu-Fang Vivienne Wu
- School of Nursing, 38028National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Kuo-Cheng Lu
- Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | | | - Yen-Yen Chen
- Department of Nursing, 38006National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Yi Tai
- School of Nursing, 38028National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Ruchi R, Bozorgmehri S, Chamarthi G, Orozco T, Mohandas R, Ozrazgat-Baslanti T, Segal MS, Shukla AM. Provision of Kidney Disease Education Service Is Associated with Improved Vascular Access Outcomes among US Incident Hemodialysis Patients. KIDNEY360 2021; 3:91-98. [PMID: 35368570 PMCID: PMC8967605 DOI: 10.34067/kid.0004502021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/24/2021] [Indexed: 01/16/2023]
Abstract
Background Pre-ESKD Kidney Disease Education (KDE) has been shown to improve multiple CKD outcomes, but its effect on vascular access outcomes is not well studied. In 2010, Medicare launched KDE reimbursements policy for patients with advanced CKD. Methods In this retrospective USRDS analysis, we identified all adult patients on incident hemodialysis with ≥6 months of pre-ESKD Medicare coverage during the first 5 years of CMS-KDE policy and divided them into CMS-KDE services recipients (KDE cohort) and nonrecipients (non-KDE cohort). The primary outcome was incident arteriovenous fistula (AVF) and the composite of incident AVF or arteriovenous graft (AVG) utilization. Secondary outcomes were central venous catheter (CVC) with maturing AVF/AVG and pure CVC utilizations. Step-wise multivariate analyses were performed in four progressive models (model 1, KDE alone; model 2, multivariate model encompassing model 1 with sociodemographics; model 3, model 2 with comorbidity and functional status; and model 4, model 3 with pre-ESKD nephrology care). Results Of the 211,990 qualifying patients on incident hemodialysis during the study period, 2887 (1%) received KDE services before dialysis initiation. The rates of incident AVF and composite AVF/AVG were more than double (30% and 35%, respectively, compared with 14% and 17%), and pure catheter use about a third lower (40% compared with 65%) in the KDE cohort compared with the non-KDE cohort. The maximally adjusted odds ratios in model 4 for study outcomes were incident AVF use, 1.78, 99% confidence interval, 1.55 to 2.05; incident AVF/AVG use, 1.78, 99% confidence interval, 1.56 to 2.03; incident CVC with maturing AVF/AVG, 1.69, 99% confidence interval, 1.44 to 1.97; and pure CVC without any AVF/AVG, 0.51, 99% confidence interval, 0.45 to 0.58. The benefits of the KDE service were maintained even after accounting for the presence, duration, and facility of ESKD care. Conclusion The occurrence of pre-ESRD KDE service is associated with significantly improved incident vascular access outcomes. Targeted studies are needed to examine the effect of KDE on patient engagement and self-efficacy as a cause for improvement in vascular access outcomes.
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Affiliation(s)
- Rupam Ruchi
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, Florida
| | - Shahab Bozorgmehri
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, Florida
| | - Gajapathiraju Chamarthi
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, Florida
| | - Tatiana Orozco
- Nephrology Section, Department of Medicine, North Florida/South Georgia Veteran Healthcare System, Gainesville, Florida
| | - Rajesh Mohandas
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, Florida,Nephrology Section, Department of Medicine, North Florida/South Georgia Veteran Healthcare System, Gainesville, Florida
| | - Tezcan Ozrazgat-Baslanti
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, Florida
| | - Mark S. Segal
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, Florida,Nephrology Section, Department of Medicine, North Florida/South Georgia Veteran Healthcare System, Gainesville, Florida
| | - Ashutosh M. Shukla
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, Florida,Nephrology Section, Department of Medicine, North Florida/South Georgia Veteran Healthcare System, Gainesville, Florida
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Shukla AM, Bozorgmehri S, Ruchi R, Mohandas R, Hale-Gallardo JL, Ozrazgat-Baslanti T, Orozco T, Segal MS, Jia H. Utilization of CMS pre-ESRD Kidney Disease Education services and its associations with the home dialysis therapies. Perit Dial Int 2021; 41:453-462. [PMID: 33258420 PMCID: PMC10038064 DOI: 10.1177/0896860820975586] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Kidney Disease Education (KDE) has been shown to improve informed dialysis selection and home dialysis use, two long-held but underachieved goals of US nephrology community. In 2010, the Center for Medicare and Medicaid Services launched a policy of KDE reimbursements for all Medicare beneficiaries with advanced chronic kidney disease. However, the incorporation of KDE service in real-world practice and its association with the home dialysis utilization has not been examined. METHODS Using the 2016 US Renal Data System linked to end-stage renal disease (ESRD) and pre-ESRD Medicare claim data, we identified all adult incident ESRD patients with active Medicare benefits at their first-ever dialysis during the study period (1 January 2010 to 31 December 2014). From these, we identified those who had at least one KDE service code before their dialysis initiation (KDE cohort) and compared them to a parsimoniously matched non-KDE control cohort in 1:4 proportions for age, gender, ESRD network, and the year of dialysis initiation. The primary outcome was home dialysis use at dialysis initiation, and secondary outcomes were home dialysis use at day 90 and anytime through the course of ESRD. RESULTS Of the 369,968 qualifying incident ESRD Medicare beneficiaries with their first-ever dialysis during the study period, 3469 (0.9%) received KDE services before dialysis initiation. African American race, Hispanic ethnicity, and the presence of congestive heart failure and hypoalbuminemia were associated with significantly lower odds of receiving KDE services. Multivariate analyses showed that KDE recipients had twice the odds of initiating dialysis with home modalities (15.0% vs. 6.9%; adjusted odds ratio (aOR):95% confidence interval (CI) 2.0:1.7-2.4) and had significantly higher odds using home dialysis throughout the course of ESRD (home dialysis use at day 90 (17.6% vs. 9.9%, aOR:CI 1.7:1.4-1.9) and cumulatively (24.7% vs. 15.1%, aOR:CI 1.7:1.5-1.9)). CONCLUSIONS Utilization of pre-ESRD KDE services is associated with significantly greater home dialysis utilization in the incident ESRD Medicare beneficiaries. The very low rates of utilization of these services suggest the need for focused systemic evaluations to identify and address the barriers and facilitators of this important patient-centered endeavor.
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Affiliation(s)
- Ashutosh M Shukla
- Division of Nephrology, 158428North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA
- Division of Nephrology, Hypertension, and Transplantation, 3463University of Florida, Gainesville, FL, USA
| | - Shahab Bozorgmehri
- Division of Nephrology, Hypertension, and Transplantation, 3463University of Florida, Gainesville, FL, USA
| | - Rupam Ruchi
- Division of Nephrology, Hypertension, and Transplantation, 3463University of Florida, Gainesville, FL, USA
| | - Rajesh Mohandas
- Division of Nephrology, 158428North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA
- Division of Nephrology, Hypertension, and Transplantation, 3463University of Florida, Gainesville, FL, USA
| | - Jennifer L Hale-Gallardo
- Division of Nephrology, 158428North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA
| | - Tezcan Ozrazgat-Baslanti
- Division of Nephrology, Hypertension, and Transplantation, 3463University of Florida, Gainesville, FL, USA
| | - Tatiana Orozco
- Division of Nephrology, 158428North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA
| | - Mark S Segal
- Division of Nephrology, 158428North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA
- Division of Nephrology, Hypertension, and Transplantation, 3463University of Florida, Gainesville, FL, USA
| | - Huanguang Jia
- Division of Nephrology, 158428North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA
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Mobile Health, Disease Knowledge, and Self-Care Behavior in Chronic Kidney Disease: A Prospective Cohort Study. J Pers Med 2021; 11:jpm11090845. [PMID: 34575622 PMCID: PMC8469557 DOI: 10.3390/jpm11090845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 01/09/2023] Open
Abstract
Mobile health (mHealth) management is an emerging strategy of care for patients with chronic diseases. However, the effect of mHealth management on clinical outcomes of patients with chronic kidney disease (CKD) has not been well-studied. The aim of this study was to investigate the additional influence of mHealth on disease knowledge and self-care behavior in CKD patients who had received traditional education. We designed and developed a new healthcare mobile application, called iCKD, which has several major features, including home-based physiological signal monitoring, disease health education, nutrition analysis, medication reminder, and alarms and a warning system. Trained nurses interviewed patients with CKD using structured questionnaires of disease knowledge and self-care behavior. After propensity score matching, we analyzed 107 patients who used iCKD and traditional education, and 107 who received traditional education. The patients who used iCKD had higher disease knowledge scores than those who received traditional education. In multivariate analysis, iCKD was significantly and positively associated with disease knowledge scores. Patients with high education levels could have greater disease knowledge through using mHealth. There was no significant difference in total scores of self-care behavior between the two groups. In conclusion, mHealth can significantly increase disease knowledge in patients with CKD.
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Tsai YC, Wang SL, Tsai HJ, Chen TH, Kung LF, Hsiao PN, Hsiao SM, Hwang SJ, Chen HC, Chiu YW. The interaction between self-care behavior and disease knowledge on the decline in renal function in chronic kidney disease. Sci Rep 2021; 11:401. [PMID: 33432037 PMCID: PMC7801646 DOI: 10.1038/s41598-020-79873-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 11/26/2020] [Indexed: 11/09/2022] Open
Abstract
Multidisciplinary care can improve the outcomes of chronic kidney disease (CKD), however the contribution of self-care behavior and knowledge about CKD is unclear. This study enrolled 454 participants with CKD stages 1-5 not on dialysis. Structured questionnaires were used to evaluate self-care behavior and kidney disease knowledge. Rapid decline in renal function was defined as the decline in estimated filtration rate > 3 ml/min per 1.73 m2/year within 1-year prior to enrollment. The mean age of all study participants was 65.8 ± 12.1 years and 55.9% were male. The elderly had better self-care behavior while younger participants had better disease knowledge. Both high self-care and high disease knowledge scores were significantly associated with and had a synergistic effect on decreasing the risk of rapid decline in renal function. CKD patients with better self-care behavior and better kidney disease knowledge had lower risk of rapid decline in renal function.
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Affiliation(s)
- Yi-Chun Tsai
- Department of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 TzYou 1st Road, Kaohsiung, 807, Taiwan.,Division of General Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Li Wang
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Ju Tsai
- Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Hui Chen
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lan-Fang Kung
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Ni Hsiao
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Ming Hsiao
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Department of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 TzYou 1st Road, Kaohsiung, 807, Taiwan.,Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Chun Chen
- Department of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 TzYou 1st Road, Kaohsiung, 807, Taiwan.,Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Wen Chiu
- Department of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 TzYou 1st Road, Kaohsiung, 807, Taiwan. .,Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan. .,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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7
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Havas K, Douglas C, Bonner A. Meeting patients where they are: improving outcomes in early chronic kidney disease with tailored self-management support (the CKD-SMS study). BMC Nephrol 2018; 19:279. [PMID: 30342487 PMCID: PMC6195997 DOI: 10.1186/s12882-018-1075-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/05/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To achieve optimal health outcomes, people with chronic kidney disease must make changes in their everyday lives to self-manage their condition. This can be challenging, and there is a need for self-management support interventions which assist people to become successful self-managers. While interventions have been developed, the literature in this area is sparse and limited by lack of both individualisation and sound theoretical basis. The aim of this study was to implement and evaluate the Chronic Kidney Disease-Self-Management Support intervention: a theory-based, person-centred self-management intervention for people with chronic kidney disease stages 1-4. METHODS A single-sample, pre-post study of an individualised, 12-week intervention based upon principles of social-cognitive theory and person-centred care was conducted with patients attending outpatient renal clinics in Queensland, Australia (N = 66). Data were collected at T0 (pre-intervention) and T1 (post-intervention). Primary outcomes were self-efficacy and self-management behaviour. RESULTS There were significant, small-to-medium improvements in primary outcomes (self-efficacy: mean difference + 0.8, 95% CI 0.3-1.2, d = 0.4; self-management behaviour: mean difference + 6.2, 95% CI 4.5-7.9, d = 0.8). There were further significant improvements in secondary outcomes (blood pressure, disease-specific knowledge, physical activity, fruit and vegetable consumption, alcohol consumption, health-related quality of life, psychological distress, and communication with healthcare providers), with effect sizes ranging from negligible to large (all ps < .05). CONCLUSIONS Social-cognitive theory shows promise as a framework for providing effective person-centred self-management support to patients within this population, and longer-term evaluation is needed. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618000066280 . Retrospectively registered 17/01/2018.
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Affiliation(s)
- Kathryn Havas
- School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, QLD 4059 Australia
- NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, St Lucia, Australia
| | - Clint Douglas
- School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, QLD 4059 Australia
| | - Ann Bonner
- School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, QLD 4059 Australia
- NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, St Lucia, Australia
- Visiting Research Fellow, Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Australia
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Donald M, Kahlon BK, Beanlands H, Straus S, Ronksley P, Herrington G, Tong A, Grill A, Waldvogel B, Large CA, Large CL, Harwood L, Novak M, James MT, Elliott M, Fernandez N, Brimble S, Samuel S, Hemmelgarn BR. Self-management interventions for adults with chronic kidney disease: a scoping review. BMJ Open 2018; 8:e019814. [PMID: 29567848 PMCID: PMC5875600 DOI: 10.1136/bmjopen-2017-019814] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To systematically identify and describe self-management interventions for adult patients with chronic kidney disease (CKD). SETTING Community-based. PARTICIPANTS Adults with CKD stages 1-5 (not requiring kidney replacement therapy). INTERVENTIONS Self-management strategies for adults with CKD. PRIMARY AND SECONDARY OUTCOME MEASURES Using a scoping review, electronic databases and grey literature were searched in October 2016 to identify self-management interventions for adults with CKD stages 1-5 (not requiring kidney replacement therapy). Randomised controlled trials (RCTs), non-RCTs, qualitative and mixed method studies were included and study selection and data extraction were independently performed by two reviewers. Outcomes included behaviours, cognitions, physiological measures, symptoms, health status and healthcare. RESULTS Fifty studies (19 RCTs, 7 quasi-experimental, 5 observational, 13 pre-post intervention, 1 mixed method and 5 qualitative) reporting 45 interventions were included. The most common intervention topic was diet/nutrition and interventions were regularly delivered face to face. Interventions were administered by a variety of providers, with nursing professionals the most common health professional group. Cognitions (ie, changes in general CKD knowledge, perceived self-management and motivation) were the most frequently reported outcome domain that showed improvement. Less than 1% of the interventions were co-developed with patients and 20% were based on a theory or framework. CONCLUSIONS There was a wide range of self-management interventions with considerable variability in outcomes for adults with CKD. Major gaps in the literature include lack of patient engagement in the design of the interventions, with the majority of interventions not applying a behavioural change theory to inform their development. This work highlights the need to involve patients to co-developed and evaluate a self-management intervention based on sound theories and clinical evidence.
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Affiliation(s)
- Maoliosa Donald
- Department of Medicine, University of Calgary, Calgary, Canada
- Interdisciplinary Chronic Disease Collaboration, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | | | - Heather Beanlands
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - Sharon Straus
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Paul Ronksley
- Interdisciplinary Chronic Disease Collaboration, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | | | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales
| | - Allan Grill
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | | | | | - Claire L Large
- Can-SOLVE CKD Network, Patient Partner, Pouce Coupe, Canada
| | | | - Marta Novak
- Centre for Mental Health, University Health Network, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Matthew T James
- Department of Medicine, University of Calgary, Calgary, Canada
- Interdisciplinary Chronic Disease Collaboration, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Meghan Elliott
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | | | - Scott Brimble
- Department of Medicine, McMaster University, Ontario, Canada
| | - Susan Samuel
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, Canada
- Interdisciplinary Chronic Disease Collaboration, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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9
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Lopez-Vargas PA, Tong A, Howell M, Craig JC. Educational Interventions for Patients With CKD: A Systematic Review. Am J Kidney Dis 2016; 68:353-70. [PMID: 27020884 DOI: 10.1053/j.ajkd.2016.01.022] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 01/22/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Preventing progression from earlier stages of chronic kidney disease (CKD) to end-stage kidney disease and minimizing the risk for cardiovascular events and other complications is central to the management of CKD. Patients' active participation in their own care is critical, but may be limited by their lack of awareness and understanding of CKD. We aimed to evaluate educational interventions for primary and secondary prevention of CKD. STUDY DESIGN Systematic review. Electronic databases were searched to December 2015, with study quality assessed using the Cochrane Collaboration risk-of-bias tool. SETTING & POPULATION People with CKD stages 1 to 5 in community and hospital settings (studies with only patients with CKD stage 5, kidney transplant recipients irrespective of glomerular filtration rate, or patients receiving dialysis were excluded). SELECTION CRITERIA FOR STUDIES Randomized controlled trials and nonrandomized studies of educational interventions. INTERVENTIONS Educational strategies in people with CKD. OUTCOMES Knowledge, self-management, quality-of-life, and clinical end points. RESULTS 26 studies (12 trials, 14 observational studies) involving 5,403 participants were included. Risk of bias was high in most studies. Interventions were multifaceted, including face-to-face teaching (26 studies), written information (20 studies), and telephone follow-up (13 studies). 20 studies involved 1-on-1 patient/educator interaction and 14 incorporated group sessions. 9 studies showed improved outcomes for quality of life, knowledge, and self-management; 9 had improved clinical end points; and 2 studies showed improvements in both patient-reported and clinical outcomes. Characteristics of effective interventions included teaching sessions that were interactive and workshops/practical skills (13/15 studies); integrated negotiated goal setting (10/13 studies); involved groups of patients (12/14 studies), their families (4/4 studies), and a multidisciplinary team (6/6 studies); and had frequent (weekly [4/5 studies] or monthly [7/7 studies]) participant/educator encounters. LIMITATIONS A meta-analysis was not possible due to heterogeneity of the interventions and outcomes measured. CONCLUSIONS Well-designed, interactive, frequent, and multifaceted educational interventions that include both individual and group participation may improve knowledge, self-management, and patient outcomes.
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Affiliation(s)
- Pamela A Lopez-Vargas
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
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Medication knowledge to be improved in participants in community universities in Taiwan: Outcome of a nationwide community university program. J Formos Med Assoc 2015; 114:1267-79. [DOI: 10.1016/j.jfma.2014.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 06/26/2014] [Accepted: 12/26/2014] [Indexed: 11/22/2022] Open
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Gray NA, Kapojos JJ, Burke MT, Sammartino C, Clark CJ. Patient kidney disease knowledge remains inadequate with standard nephrology outpatient care. Clin Kidney J 2015; 9:113-8. [PMID: 26798471 PMCID: PMC4720188 DOI: 10.1093/ckj/sfv108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 10/01/2015] [Indexed: 11/23/2022] Open
Abstract
Background Chronic kidney disease (CKD) knowledge among patients newly referred to a nephrology clinic is limited. This study aimed to determine if CKD knowledge 1 year after initial consultation in a nephrology clinic improves with standard care. Methods Patients newly referred to a nephrology outpatient clinic received standard care from nephrologists, and had access to educational pamphlets, relevant internet sites and patient support groups. Those with estimated glomerular filtration rate <20 mL/min/1.73 m2 received individual education from a multi-disciplinary team. Knowledge was assessed by questionnaire at first visit and after 12 months. Results Of 210 patients at baseline, follow-up data were available at 12.7 (±1.7) months for 95. Median age was 70 [interquartile range (IQR) 60–76] years and 54% were male. Baseline median creatinine of the follow-up cohort was 137 (IQR 99–179) µmol/L. Eighty per cent had seen a nephrologist at least three times, 8% saw a CKD nurse, 50% reported collecting pamphlets and 16% reported searching the internet. At 12 months, fewer patients reported being uncertain why they had been referred (5 versus 20%, P = 0.002) and fewer reported being unsure of the meaning of CKD (37 versus 57%, P = 0.005). Unknown (44%) and alcohol (23%) remained the most common causes of CKD identified. Fewer patients responded ‘unsure’ regarding the treatment of CKD (38 versus 57%, P = 0.004). Conclusions After a year of standard care at nephrology outpatient clinics there were some minor improvements in patient knowledge; however, patient understanding of CKD remained poor.
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Affiliation(s)
- Nicholas A Gray
- Department of Nephrology, Nambour General Hospital, Nambour, QLD, Australia; The University of Queensland, Sunshine Coast Clinical School, Nambour General Hospital, Nambour, QLD, Australia
| | - Jola J Kapojos
- Department of Nephrology , Alice Springs Hospital , Alice Springs, NT , Australia
| | - Michael T Burke
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia; The University of Queensland, School of Medicine, Brisbane, QLD, Australia
| | | | - Carolyn J Clark
- Department of Nephrology, Nambour General Hospital, Nambour, QLD, Australia; The University of Queensland, Sunshine Coast Clinical School, Nambour General Hospital, Nambour, QLD, Australia
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Ghadam MS, Poorgholami F, Badiyepeymaie Jahromi Z, Parandavar N, Kalani N, Rahmanian E. Effect of Self-Care Education by Face-to-Face Method on the Quality of Life in Hemodialysis Patients (Relying on Ferrans and Powers Questionnaire). Glob J Health Sci 2015; 8:121-7. [PMID: 26755485 PMCID: PMC4954909 DOI: 10.5539/gjhs.v8n6p121] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/21/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUTION One of the most common methods to control chronic renal failure, Hemodialysis creates numerous changes in the style and the quality of life in patients. Educating patients is one of effective factors to improve the quality of life. The present study aims to investigate influences of self-care education by face-to-face method on determining quality of life in hemodialysis patients in Jahrom, Iran, during 2014-2015. METHODS This is a quasi-experimental, single-blind study in which 50 patients undergoing hemodialysis at Shahaid Mottahari Hospital, Jahrom. The patients were placed in two groups of 25 individuals: the face to face educational group and the control group. The control group received only routine care in hemodialysis unit. The face to face educational group received 8 instruction sessions of 60 minutes before starting dialysis and received an instruction booklet. Data collection tools were a questionnaire consisting of demographic characteristics, a checklist of needs assessment for hemodialysis patients and a quality of life questionnaire, whose reliability and validity were previously approved. The questionnaires were completed face to face, before and after the intervention. RESULTS The results show that the research units did not have any significant difference in terms of demographic variables. Also increase in various aspects of the quality of life compared with the control group is observed after the intervention in the face to face educational group (p<0.001). DISCUSSION & CONCLUSION Given the results, representation of adequate training in hemodialysis ward can cause improve in physical function, mental health and thus increase the quality of life in hemodialysis patients, through raising the awareness level.
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13
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Walker RC, Marshall MR, Polaschek NR. A prospective clinical trial of specialist renal nursing in the primary care setting to prevent progression of chronic kidney: a quality improvement report. BMC FAMILY PRACTICE 2014; 15:155. [PMID: 25239726 PMCID: PMC4263018 DOI: 10.1186/1471-2296-15-155] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 09/16/2014] [Indexed: 01/31/2023]
Abstract
Background Early detection and effective management of risk factors can potentially delay progression of chronic kidney disease (CKD) to end-stage kidney disease, and decrease mortality and morbidity from cardiovascular (CV) disease. We evaluated a specialist nurse-led intervention in the primary care setting to address accepted risk factors in a study sample of adults at ‘high risk of CKD progression’, defined as uncontrolled type II diabetes and/or hypertension and a history of poor clinic attendance. Methods The study was a non-controlled quality improvement study with pre- and post- intervention comparisons to test feasibility and potential effectiveness. Patients within two primary care practices were screened and recruited to the study. Fifty-two patients were enrolled, with 36 completing 12-months follow-up. The intervention involved a series of sessions led by the nephrology Nurse Practitioner with assistance from practice nurses. These sessions included assessment, education and planned medication and lifestyle changes. The primary outcome measured was proteinuria (ACR), and the secondary outcomes estimated glomerular filtration rate (eGFR) and 5-year absolute CV risk. Several ‘intermediary’ secondary outcomes were also measured including: blood pressure, serum total cholesterol, glycosylated haemoglobin (HbA1c), body mass index (BMI), prevalence of active smoking, a variety of self-management domains, and medication prescription. Analysis of data was performed using linear and logistic regression as appropriate. Results There was a significant improvement in ACR (average decrease of −6.75 mg/mmol per month) over the course of the study. There was a small but significant decrease in eGFR and a reduction in 5 year absolute CV risk. Blood pressure, serum total cholesterol, and HbA1c all decreased significantly. Adherence to lifestyle advice improved with a significant reduction in prevalence of active smoking, although there was no significant change in BMI. Self-management significantly improved across all relevant domains. Conclusions The results suggest that a collaborative model of care between specialist renal nurses and primary care clinicians may improve the management of risk factors for progression of CKD and CV death. Further larger, controlled studies are warranted to definitively determine the effectiveness and costs of this intervention. Trial registration Australian and New Zealand Clinical Trials Registry number: ACTRN12613000791730 Electronic supplementary material The online version of this article (doi:10.1186/1471-2296-15-155) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Mark R Marshall
- Counties Manukau District Health Board, Auckland, New Zealand.
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14
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Bonner A, Havas K, Douglas C, Thepha T, Bennett P, Clark R. Self-management programmes in stages 1-4 chronic kidney disease: a literature review. J Ren Care 2014; 40:194-204. [PMID: 24628848 DOI: 10.1111/jorc.12058] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a complex health problem, which requires individuals to invest considerable time and energy in managing their health and adhering to multifaceted treatment regimens. OBJECTIVES To review studies delivering self-management interventions to people with CKD (Stages 1-4) and assess whether these interventions improve patient outcomes. DESIGN Systematic review. METHODS Nine electronic databases (MedLine, CINAHL, EMBASE, ProQuest Health & Medical Complete, ProQuest Nursing & Allied Health, The Cochrane Library, The Joanna Briggs Institute EBP Database, Web of Science and PsycINFO) were searched using relevant terms for papers published between January 2003 and February 2013. RESULTS The search strategy identified 2,051 papers, of which 34 were retrieved in full with only 5 studies involving 274 patients meeting the inclusion criteria. Three studies were randomised controlled trials, a variety of methods were used to measure outcomes, and four studies included a nurse on the self-management intervention team. There was little consistency in the delivery, intensity, duration and format of the self-management programmes. There is some evidence that knowledge- and health-related quality of life improved. Generally, small effects were observed for levels of adherence and progression of CKD according to physiologic measures. CONCLUSION The effectiveness of self-management programmes in CKD (Stages 1-4) cannot be conclusively ascertained, and further research is required. It is desirable that individuals with CKD are supported to effectively self-manage day-to-day aspects of their health.
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Affiliation(s)
- Ann Bonner
- School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia; CKD.QLD and Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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Kesänen J, Leino-Kilpi H, Arifulla D, Siekkinen M, Valkeapää K. Knowledge tests in patient education: a systematic review. Nurs Health Sci 2013; 16:262-73. [PMID: 24256595 DOI: 10.1111/nhs.12097] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 09/03/2013] [Accepted: 09/06/2013] [Indexed: 11/30/2022]
Abstract
This study describes knowledge tests in patient education through a systematic review of the Medline, Cinahl, PsycINFO, and ERIC databases with the guidance of the PRISMA Statement. Forty-nine knowledge tests were identified. The contents were health-problem related, focusing on biophysiological and functional knowledge. The mean number of items was 20, with true-false or multiple-choice scales. Most of the tests were purposely designed for the studies included in the review. The most frequently reported quality assessments of knowledge tests were content validity and internal consistency. The outcome measurements for patient-education needs were comprehensive, validating knowledge tests that cover multidimensional aspects of knowledge. Besides the measurement of the outcomes of patient education, knowledge tests could be used for several purposes in patient education: to guide the content of education as checklists, to monitor the learning process, and as educational tools. There is a need for more efficient content and health problem-specific knowledge-test assessments.
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Affiliation(s)
- Jukka Kesänen
- Department of Nursing Science, University of Turku, Turku, Finland; Hospital Orton, Helsinki, Finland
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Wright Nunes JA. Education of patients with chronic kidney disease at the interface of primary care providers and nephrologists. Adv Chronic Kidney Dis 2013; 20:370-8. [PMID: 23809290 DOI: 10.1053/j.ackd.2013.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 03/25/2013] [Accepted: 03/25/2013] [Indexed: 11/11/2022]
Abstract
Patient education is promoted as an integral part of effective kidney disease management. Programs and tools are available for providers and patients to support patient CKD education in primary care and nephrology. Challenges to providing patient education across practice settings include patients' lack of awareness of CKD as a medical entity, physician perceptions of their own lack of skill and ability to educate patients, differences in how primary care and nephrology physicians perceive collaborative care, and shortage of staff and time to support educational efforts. In addition, there is little research available to guide evidence-based practices for implementing early patient CKD education interventions across medical disciplines. Development and testing of patient education programs using early CKD multidisciplinary care, educational websites, and phone-based applications are all areas of growing research. More work is needed to provide evidence and support that physicians and other health professionals need to ensure a seamless patient education experience across the continuum of care.
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Teng HL, Yen M, Fetzer S, Sung JM, Hung SY. Effects of targeted interventions on lifestyle modifications of chronic kidney disease patients: randomized controlled trial. West J Nurs Res 2013; 35:1107-27. [PMID: 23618821 DOI: 10.1177/0193945913486202] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Targeting interventions to an individual's readiness to modify lifestyle factors, specifically diet and exercise behaviors, may delay chronic kidney disease (CKD) progression. This study examined the effects of a targeted Lifestyle Modification Program based on the readiness to change health-promotion lifestyle behaviors, renal protection knowledge, and physical indicators of patients with early CKD. A repeated-measures design randomized 160 CKD patients from four southern Taiwan outpatient nephrology clinics into control and intervention groups. Data were collected five times over a year with a participant retention rate of 64.4%. The intervention group demonstrated significant improvement with regard to diet behavior modifications. Compared with the control group, the intervention group showed a significant improving trend of renal function protection knowledge, stress management, and interpersonal relations. Targeted interventions for patients in the early phases of CKD promotes adherence to proper diet, exercise behavior, and positive lifestyle modifications.
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Wright Nunes J, Greene JH, Wallston K, Eden S, Shintani A, Elasy T, Rothman RL, Ikizler TA, Cavanaugh KL. Pilot study of a physician-delivered education tool to increase patient knowledge about CKD. Am J Kidney Dis 2013; 62:23-32. [PMID: 23540261 DOI: 10.1053/j.ajkd.2013.01.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 01/16/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Limited research exists on physician-delivered education interventions. We examined the feasibility and impact of an educational tool on facilitating physician-patient kidney disease communication. STUDY DESIGN Pilot feasibility clinical trial with a historical control to examine effect size on patient knowledge and structured questions to elicit physician and patient feedback. SETTING & PARTICIPANTS Adults with chronic kidney disease (CKD) stages 1-5, seen in nephrology clinic. INTERVENTION 1-page educational worksheet, reviewed by physicians with patients. OUTCOMES Kidney knowledge between patient groups and provider/patient feedback. MEASUREMENTS Patient kidney knowledge was measured using a previously validated questionnaire compared between patients receiving the intervention (April to October 2010) and a historical cohort (April to October 2009). Provider input was obtained using structured interviews. Patient input was obtained through survey questions. Patient characteristics were abstracted from the medical record. RESULTS 556 patients were included, with 401 patients in the historical cohort and 155 receiving the intervention. Mean age was 57 ± 16 (SD) years, with 53% men, 81% whites, and 78% with CKD stages 3-5. Compared with the historical cohort, patients receiving the intervention had higher adjusted odds of knowing they had CKD (adjusted OR, 2.20; 95% CI, 1.16-4.17; P = 0.02), knowing their kidney function (adjusted OR, 2.25; 95% CI, 1.27-3.97; P = 0.005), and knowing their stage of CKD (adjusted OR, 3.22; 95% CI, 1.49-6.92; P = 0.003). Physicians found the intervention tool easy and feasible to integrate into practice and 98% of patients who received the intervention recommended it for future use. LIMITATIONS Study design did not randomly assign patients for comparison and enrollment was performed in clinics at one center. CONCLUSIONS In this pilot study, a physician-delivered education intervention was feasible to use in practice and was associated with higher patient kidney disease knowledge. Further examination of physician-delivered education interventions for increasing patient disease understanding should be tested through randomized trials.
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Affiliation(s)
- Julie Wright Nunes
- Department of Internal Medicine, Division of Nephrology, University of Michigan Health System, Ann Arbor, MI, USA
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Bonner A, Lloyd A. Exploring the information practices of people with end-stage kidney disease. J Ren Care 2012; 38:124-30. [PMID: 22429920 DOI: 10.1111/j.1755-6686.2012.00258.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This small exploratory study sought to understand how people with End-Stage Kidney Disease (ESKD) experience the information environment and what information practices they employ in order to inform the decisions they make in relation to treatment and care. Using a constructivist methodology, in-depth interviews were conducted with five people who were receiving haemodialysis in two small satellite dialysis units located in regional and rural communities in New South Wales, Australia. Thematic analysis revealed two types of patients. The first type appears to adopt a received view of information, who do not question their condition; and passively accept information. In the other type, patients were found to be engaged; they actively identified their information needs and quickly learned what that they needed to ask and who to ask. Knowing the information practices of people with ESKD is useful for nephrology nurses when providing patient education.
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Affiliation(s)
- Ann Bonner
- School of Nursing and Midwifery, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059, Australia.
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Choi ES, Lee J. Effects of a Face-to-face Self-management Program on Knowledge, Self-care Practice and Kidney Function in Patients with Chronic Kidney Disease before the Renal Replacement Therapy. J Korean Acad Nurs 2012; 42:1070-8. [DOI: 10.4040/jkan.2012.42.7.1070] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Eun Sung Choi
- Education Graduate School, Kyung Hee University, Seoul, Korea
| | - Jia Lee
- College of Nursing Science, East-West Nursing Research Institute, Kyung Hee University, Seoul, Korea
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Goldfarb-Rumyantzev AS, Rout P, Sandhu GS, Khattak M, Tang H, Barenbaum A. Association between social adaptability index and survival of patients with chronic kidney disease. Nephrol Dial Transplant 2010; 25:3672-81. [PMID: 20353959 DOI: 10.1093/ndt/gfq177] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND While individual socioeconomic factors have been associated with clinical outcome, a composite index has not been developed. In this project, we tested the hypothesis that Social Adaptability Index (SAI) based on employment, education, income, marital status and substance abuse is associated with survival in chronic kidney disease (CKD) patients. METHODS This is a retrospective cohort study of patients with CKD stage 2 or greater. We used the Third National Health and Nutrition Examination Survey (NHANES III) cohort data between 1988 and 1994 including those 18 years or older. Our primary variable of interest is SAI. Each component of SAI (employment status, education, marital status, and substance abuse) has been graded on the scale of 0-3, income has been graded on the scale 0-1. Age, sex, race, diabetes, co-morbidity index, body mass index (BMI), geographic location, haemoglobin, serum creatinine, serum albumin, serum cholesterol and Hba1c were used as covariates in multivariate analysis. The outcome of the study is patient's mortality. The time to death was calculated as time between the first interview by NHANES and death. RESULTS We analysed 13 400 subjects with mean age of 50.6 ± 20-53.6% males, 44.4% white, 29.7% African American and 22.1% Mexican American-with 8.5% having diabetes, with an average number of co-morbid conditions of 2.7 ± 1.1. Lower SAI is associated with greater stage of CKD. Higher SAI was associated with decreased mortality [hazard ratio (HR) 0.88, P < 0.001, 95% confidence interval (CI) 0.86-0.89]. When SAI quintiles were analysed, we demonstrated a 'dose-dependent' association between SAI and survival. Subgroup analysis showed that this association of SAI and survival was present in all studied subgroups. The limitations of the study include retrospective design, potential misreporting and misclassification, and reverse causality. CONCLUSION We demonstrated that SAI has a strong and clinically significant association with mortality in CKD patients.
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Vilaplana JMG, Zampieron A, Craver L, Buja A. EVALUATION OF PSYCHOLOGICAL OUTCOMES FOLLOWING THE INTERVENTION ‘TEACHING GROUP’: STUDY ON PREDIALYSIS PATIENTS. J Ren Care 2009; 35:159-64. [DOI: 10.1111/j.1755-6686.2009.00113.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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