Expanding Capd in Low-Resource Settings: A Distance Learning Approach

Abstract

Background Despite growing need, treatment for end-stage renal disease is limited in low- and middle-income countries due to resource restraints. We describe the development of an educational curriculum and quality improvement program to support continuous ambulatory peritoneal dialysis (CAPD) performed primarily by non-nephrology providers in Sri Lanka. Methods We developed a program of education, outcome tracking, and expert consultation to support providers in Kandy, Sri Lanka. Education included videos and in-person didactics covering core topics in CAPD. Event-tracking sheets recorded root causes and management of infections and hospitalizations. Conferences reviewed clinical cases and overall clinic management. We evaluated the patient census, peritonitis rates, and root causes and management of infections over 1 year. Results The curriculum was published through the International Society of Nephrology online academy. High provider turnover limited curriculum assessments. The CAPD patient census rose from 63 to 116 during the year. The peritonitis rate declined significantly, from 0.8 episodes per patient-year in the first 6 months to 0.3 in the latter 6 months, though the most common root causes of peritonitis, related to contamination events and hygiene, persisted. The appropriate ascertainment of culture data and prescription of antibiotics also increased. Conclusions Our project supported the expansion of a CAPD program in a resource-limited setting, while also improving peritonitis outcomes. Ongoing challenges include ensuring a durable educational system for rotating providers, tracking outcomes beyond peritonitis, and formalizing management protocols. Our program can serve as an example of how established dialysis programs can support the burgeoning work of providers in resource-limited setting.

Targeted Education ApproaCH to improve Peritoneal Dialysis Outcomes (TEACH-PD): A feasibility study

“…This theory has been critiqued by a wide variety of neuroscientists, psychologists and others. 34,35 However, in more recent articles on adult learning styles, 36 there is evidence that teaching to only one style is flawed. 37…”

“…This theory has been critiqued by a wide variety of neuroscientists, psychologists and others. 34,35 However, in more recent articles on adult learning styles, 36 there is evidence that teaching to only one style is flawed. 37 The evidence on wide variation in PD peritonitis risk seems to be predominantly related to centre rather than patient-level factors.…”

Challenges Facing Children on Chronic Peritoneal Dialysis in South Africa

“…Lobbying government to address the social determinants of health and to focus on the early detection of CKD, even in children, should be our priority (25). Innovations such as the establishment of satellite dialysis units at strategically positioned secondary-level hospitals (29) and the application of information technology and distance learning (30) to allow for the management of CKD in children far away from tertiary centers should become our focus. The infrastructure to deploy such technologies exists in South Africa and there is no reason why, with investment, training, and imagination, they cannot also be applied and implemented here.…”

The use of virtual physician mentoring to enhance home dialysis knowledge and uptake

“…As a way to increase opportunities for CPE and improve access to CPE for more community and rural practitioners, there has been a T A B L E 1 Review of select home dialysis related conferences in North America Rope and colleagues 50 programme. 25 Sinclair and colleagues 53 performed a systematic review of asynchronous e-learning in medicine.…”