Avaliação de programa de ensino-aprendizagem sobre metabolismo de cálcio e fósforo para pacientes em hemodiálise

Araujo, Lílian Peres Righetto de; Figueiredo, Ana Elizabeth; d'Avila, Domingos O.

doi:10.1590/s0080-62342010000400010

Cited by 9 publications

(3 citation statements)

References 14 publications

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“…Wait-listed controls were employed in three studies [10, 32, 41], while the remaining studies used some type of intervention as a comparator to match the active intervention. The comparator included attention control [25], placebo support and discussion control conditions [34], provision of matching health information without prior reaffirmation activity [48, 49], use of a daily activity monitoring application [47], and health education which was different from the trialled intervention [13, 28]. Four studies [7, 25, 27, 35] included in this review also had two or more active (partial or alternative) intervention arms in addition to the main intervention and control arms (refer to Table 1).…”

Section: Resultsmentioning

confidence: 99%

Strategies to improve dietary, fluid, dialysis or medication adherence in patients with end stage kidney disease on dialysis: A systematic review and meta-analysis of randomized intervention trials

et al. 2019

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BackgroundIn patients with end stage kidney disease (ESKD) on dialysis, treatment non-adherence is common and results in poor health outcomes. However, the clinical benefits of interventions to improve adherence in dialysis patients are difficult to evaluate since trialled interventions and reported outcomes are highly diverse/ heterogeneous. This review summarizes existing literature on randomized controlled trials (RCTs) evaluating adherence interventions in ESKD patients focusing on the intervention category, outcome efficacy and persistence of benefit beyond the intervention.MethodsWe performed electronic database searches in Medline, Embase & Cochrane CENTRAL upto 1st July 2018 for RCTs evaluating interventions to improve diet, fluid, medication or dialysis adherence in ESKD patients. Study characteristics including category of interventions, outcomes, efficacy and follow-up were assessed. Meta-analysis was used to compute pooled estimates of the effects on the commonest reported outcome measures.ResultsFrom 1311 citations, we included 36 RCTs (13 cluster-randomized trials), recruiting a total of 3510 dialysis patients (mean age 55.1 ± 5.8 years, males 58.1%). Overall risk of bias was ‘high’ for 24 and of ‘some concern’ for 12 studies. Most interventions (33 trials, 92%) addressed patient related factors, and included educational/cognitive (N = 11), behavioural / counselling (N = 4), psychological/affective (N = 4) interventions or a combination (N = 14) of the above. A majority of (28/36) RCTs showed improvement in some reported outcomes. Surrogate measures like changes in phosphate (N = 19) and inter-dialytic weight gain (N = 15) were the most common reported outcomes and both showed significant improvement in the meta-analysis. Sixteen trials reported follow-up (1–12 months) beyond intervention and the benefits waned or were absent in nine trials within 12 months post-intervention.ConclusionsInterventions to improve treatment adherence result in modest short-term benefits in surrogate outcome measures in dialysis patients, but significant improvements in trial design and outcome reporting are warranted to identify strategies that would achieve meaningful and sustainable clinical benefits.LimitationsPoor methodological quality of trials. Frequent use of surrogate outcomes measures. Low certainly of evidence.

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Section: Resultsmentioning

confidence: 99%

Strategies to improve dietary, fluid, dialysis or medication adherence in patients with end stage kidney disease on dialysis: A systematic review and meta-analysis of randomized intervention trials

et al. 2019

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“… 33 Patients need to be effectively educated about the risk associated with phosphate binder nonadherence and, specifically, its association with increased morbidity and mortality. 14 , 19 , 72 Patient education about appropriate timing of dosing toward the end of each meal, as well as adjusting dosing to the phosphorus content of the food, is important to ensure binder efficacy. 14 …”

Section: Interventions To Improve Phosphate Binder Adherencementioning

confidence: 99%

Phosphate-control adherence in hemodialysis patients: current perspectives

Umeukeje¹,

Mixon²,

Cavanaugh³

2018

PPA

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ObjectivesThis review summarizes factors relevant for adherence to phosphate-control strategies in dialysis patients, and discusses interventions to overcome related challenges.MethodsA literature search including the terms “phosphorus”, “phosphorus control”, “hemo-dialysis”, “phosphate binder medications”, “phosphorus diet”, “adherence”, and “nonadherence” was undertaken using PubMed, PsycInfo, CINAHL, and Embase.ResultsHyperphosphatemia is associated with cardiovascular and all-cause mortality in dialysis patients. Management of hyperphosphatemia depends on phosphate binder medication therapy, a low-phosphorus diet, and dialysis. Phosphate binder therapy is associated with a survival benefit. Dietary restriction is complex because of the need to maintain adequate protein intake and, alone, is insufficient for phosphorus control. Similarly, conventional hemodialysis alone is insufficient for phosphorus control due to the kinetics of dialytic phosphorus removal. Thus, all three treatment approaches are important contributors, with dietary restriction and dialysis as adjuncts to the requisite phosphate binder therapy. Phosphate-control adherence rates are suboptimal and are influenced directly by patient, provider, and phosphorus-control strategy-related factors. Psychosocial factors have been implicated as influential “drivers” of adherence behaviors in dialysis patients, and factors based on self-motivation associate directly with adherence behavior. Higher-risk subgroups of nonadherent patients include younger dialysis patients and non-whites. Provider attitudes may be important – yet unaddressed – determinants of adherence behaviors of dialysis patients.ConclusionAdherence to phosphate binders, low-phosphorus diet, and dialysis prescription is suboptimal. Multicomponent strategies that concurrently address therapy-related factors such as side effects, patient factors targeting self-motivation, and provider factors to improve attitudes and delivery of culturally sensitive care show the most promise for long-term control of phosphorus levels. Moreover, it will be important to identify patients at highest risk for lack of control, and for programs to be ready to deliver flexible person-centered strategies through training and dedicated resources to align with the needs of all patients.

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“…As limitações dietéticas e comportamentais impostas pela doença e a multiplicidade das medidas terapêuticas associadas à falta de conhecimento dos pacientes e seus familiares contribuem para a má adesão ao tratamento, sendo responsabilidade da equipe multiprofissional orientar o paciente e seus familiares sobre a doença e o tratamento através de uma linguagem clara e adequada ao entendimento e nível de escolaridade dos envolvidos 11 .…”

Section: Revisão De Literaturaunclassified

Percepção dos profissionais de saúde sobre os fatores para a adesão ao tratamento hemodialítico [Health personnel’s perceptions of factors influencing hemodialysis treatment adherence] [Percepción de los profesionales de la salud acerca de los factores para la adhesión al tratamiento hemodialítico]

Ferraz¹,

Maciel²,

Borba³

et al. 2017

Rev. enferm. UERJ

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Objetivo: investigar a percepção de profissionais de saúde sobre os fatores que interferem na adesão ao tratamento hemodialítico. Método: trata-se de estudo descritivo com abordagem qualitativa, realizado com 41 profissionais de um serviço de hemodiálise no Nordeste do Brasil, em 2014. Os dados foram coletados mediante roteiro semiestruturado e analisados pelo software Alceste. Estudo aprovado pelo Comitê de Ética da instituição, CAEE: 28265814.5.0000.5197. Resultados: foram classificadas 173 unidades de contextos elementares que foram divididos em quatro classes discursivas: Vínculo profissional-paciente como suporte nas dificuldades iniciais do tratamento; Conhecimento do paciente renal sobre a doença e seu tratamento como uma estratégia para adesão; Despersonificação do sujeito aliado ao déficit de conhecimento e medo no implante do cateter; Paciente, família e profissionais como aliança na promoção do autocuidado. Conclusão: são fatores relevantes à adesão: comunicação, orientação, acolhimento e a família são pontos chave na adesão à terapêutica. ABSTRACTObjective: to investigate health personnel’s perceptions of factors influencing hemodialysis treatment adherence. Method: in this qualitative, descriptive study of 41 personnel in a hemodialysis service in northeastern Brazil, data were collected in 2014 by semi-structured interview and analyzed using Alceste software. The study was approved by the ethics committee (CAEE: 28265814.5.0000.5197). Results: 173 units of elementary contexts we classified and divided into four discursive classes: the patient-personnel bond as support in initial treatment difficulties; the renal patient’s knowledge about the disease and its treatment as a strategy for adherence; depersonalization of the subject, allied to knowledge deficit and fear at catheter implantation; and patient, family and health personnel as an alliance in promoting self-care. Conclusion: communication, guidance, “embracement” and family are key to adherence to therapy.RESUMENObjetivo: investigar la percepción de profesionales de la salud acerca de los factores que interfieren en la adhesión al tratamiento hemodialítico. Método: se trata de un estudio descriptivo con enfoque cualitativo, realizado junto a 41 profesionales de un servicio de hemodiálisis en el Nordeste de Brasil, en 2014. Los datos fueron recolectados por medio de un guion semiestructurado y analizados por el software Alceste. Estudio aprobado por el Comité de la institución, CAEE: 28265814.5.0000.5197. Resultados: se clasificaron 173 unidades de contextos elementales que se dividieron en cuatro clases discursivas: vínculo profesional-paciente como apoyo en las dificultades iniciales del tratamiento; conocimiento del paciente renal sobre la enfermedad y su tratamiento como una estrategia para la adhesión; despersonalización del sujeto aliado al déficit de conocimiento y miedo en el implante del catéter; paciente, familia y profesionales como alianza en la promoción del autocuidado. Conclusión: comunicación, orientación, acogida y familia son puntos clave en la adhesión a la terapéutica. DOI: http://dx.doi.org/10.12957/reuerj.2017.15504

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Avaliação de programa de ensino-aprendizagem sobre metabolismo de cálcio e fósforo para pacientes em hemodiálise

Cited by 9 publications

References 14 publications

Strategies to improve dietary, fluid, dialysis or medication adherence in patients with end stage kidney disease on dialysis: A systematic review and meta-analysis of randomized intervention trials

Strategies to improve dietary, fluid, dialysis or medication adherence in patients with end stage kidney disease on dialysis: A systematic review and meta-analysis of randomized intervention trials

Phosphate-control adherence in hemodialysis patients: current perspectives

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