Effects of A Comprehensive Predialysis Education Program on the Home Dialysis Therapies: A Retrospective Cohort Study

Shukla, Ashutosh; Easom, Andrea; Singh, Manisha; Pandey, Richa; Rotaru, Dumitru; Wen, Xuerong; Shah, Sudhir V.

doi:10.3747/pdi.2016.00270

Cited by 28 publications

(46 citation statements)

References 17 publications

(26 reference statements)

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“…Our prior study showed that even when mandated for their care only half the patients prefer coming for a second session of the CPE and the CPE attendance beyond 3 sessions is uncommon. [20] The current findings show the patient attendance pattern for CPE, if CPE is not mandated for their CKD care. About quarter of the patients did not attend any CPE despite the protocol for uniform CPE and repetitive efforts.…”

Section: Discussionmentioning

confidence: 83%

“…[19] The results of this study are highly congruent to our prior published study using the same CPE protocol, with HoD selection rates of 70% and 74%, and rapidly rising HoD prevalence rates over 18 months. [20] We believe this provides evidence that with appropriate training, our concise CPE protocol can be implemented across any similar large healthcare infrastructure to improve informed dialysis choice and HoD rates.…”

Section: Discussionmentioning

confidence: 96%

“…We have developed a concise CPE protocol, and recently showed that our concise protocol when interwoven within the ongoing clinical nephrology care within a university network, can substantially improve informed HoD choice and use, and increase HoD prevalence. [20] However, this requires establishing CPE resources within each nephrology practice. Efficacy of a stand-alone, educational model of CPE that can be disseminated across multiple practices has not been tested for US patients.…”

Section: Introductionmentioning

confidence: 99%

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What do the US advanced kidney disease patients want? Comprehensive pre-ESRD Patient Education (CPE) and choice of dialysis modality

et al. 2019

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Improvement in Home Dialysis (HoD) utilizations as a mean to improve the patient reported and health services outcomes, has been a long-held goal of the providers and healthcare system in United States. However, measures to improve HoD rates have yielded limited success so far. Lack of patient awareness of chronic kidney disease (CKD) and its management options, is one of the important barriers against patient adoption of HoD. Despite ample evidence that Comprehensive pre-ESERD Patient Education (CPE) improves patient awareness and informed HoD choice, use of CPE among US advanced CKD patients is low. Need for significant resources, lack of validated data showing unequivocal and reproducible benefits, and the lack of validated CPE protocols proven to have consistent efficacy in improving not only patient awareness but also HoD rates in US population, are major limitations deterring adoption of CPE in routine clinical practice. We recently demonstrated that if a structured, protocol based CPE is integrated within the routine nephrology care for patients with advanced CKD, it substantially improves informed HoD choice and utilizations. However, this requires establishing CPE resources within each nephrology practice. Efficacy of a stand-alone CPE model, independent of clinical care, has not been examined till date. In this report we report the efficacy of our structured CPE protocol, delivered outside the realm of routine nephrology care—as a stand-alone patient education program, in a geographically distant region, and show that: when provided opportunity for informed dialysis choice, a majority of advanced CKD patients in US would prefer HoD. We also show that initiating CPE leads to accelerated growth in HoD utilizations and reduces disparities in HoD utilizations, goals for system improvements. Finally, the reproducibility of our structured CPE protocol with consistent efficacy data suggest that initiating such programs at institutional levels has the potential to improve informed dialysis selection and HoD rates across any similar large healthcare institute within US.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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What do the US advanced kidney disease patients want? Comprehensive pre-ESRD Patient Education (CPE) and choice of dialysis modality

et al. 2019

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“…One area of need is educating CKD patients so that they have a better understanding of their disease, increase efforts to slow down progression and become active partners in their health care team [ 2 ]. When there is a decline in kidney function, patients should be in a position to choose the optimal modality individualized to their lifestyle.…”

Section: Introductionmentioning

confidence: 99%

Home run—results of a chronic kidney disease Telemedicine Patient Education Study

Easom

Shukla

Rotaru

et al. 2019

Clinical Kidney Journal

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Background Chronic kidney disease (CKD) incidence is increasing and associated mortality and morbidity are high. Educating patients is effective in delaying progression and establishing optimal renal replacement therapy (RRT). Tele-education/telemedicine (TM) can be an effective tool to provide such education, but there are no available data quantifying its effectiveness. We attempted to establish such evidence correlating the effect of education in patient choices and with the start of actual RRT. We present results from a 3-year pilot study evaluating the effectiveness of comprehensive predialysis education (CPE) through TM for CKD patients compared with a standard care group [face to face (FTF)]. The patient’s ability to choose RRT was the primary endpoint. Methods This was a randomized controlled study providing CPE over three classes at nine sites (one FTF and eight TM). Three assessment tools were utilized to compare groups: CKD knowledge, literacy and quality of life. Results A total of 47.1% of FTF and 52.2% of TM patients reported not having enough information to choose a modality. This decreased by the third visit (FTF 7.4%, TM 13.2%). Home modality choices more than doubled in both groups (FTF 25.8–67.7%, TM 22.2–50.1%). In patients that completed one visit and needed to start RRT, 47% started on a home modality or received a pre-emptive transplant (home hemodialysis 6%, peritoneal dialysis 38%, transplant 3%). Conclusions Results show almost 90% (TM 87%, FTF 95%) of the attendees could choose a modality after education. Home modality choices doubled. Patients were able to make an informed choice regardless of the modality of education.

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“…Ainsi, la promotion de la dialyse à domicile passe par une implication forte des acteurs médicaux et para-médicaux, afin de rendre le traitement accessible aux patients 13 . Les prérequis sont d'une part la formation des infirmières spécialisées [14][15] et des médecins et d'autre part la mise au point d'un programme d'information prédialyse dont la qualité a un impact majeur sur l'orientation des patients vers l'une ou l'autre des modalités proposées [16][17][18] . De nombreux freins peuvent être à l'origine du faible développement de la dialyse à domicile en France, mais l'hétérogénéité d'utilisation de ces techniques sur le territoire montre que ces freins peuvent être atténués 6,19,20 .…”

Section: Introductionunclassified

Home dialysis : what are the barriers . A French nephrologist survey

Geneviève¹,

Bataille²,

Beaume³

et al. 2019

Bull Dial Domic

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Home dialysis, which includes Peritoneal Dialysis and Home Hemodialysis, provides lots of profit to patients suffering of Chronic Kidney Disease, especially in terms of comfort, life quality and autonomy. However, its use is marginal in France, with an inhomogenous distributaion according to geographical regions. We conducted a French national survey of nephrologists to assess the barriers to the development of home dialysis. After analyzing the responses of the 230 participating nephrologists, the main obstacles to the development of the two techniques were identified and classified according to their reporting rate. The major obstacles that emerge from the survey are : the lack of information among the general public, a lack of acknowledgement of nurses specializing in these techniques, the limited number of structures that practice dialysis at home, and information difficulties among patient about dialysis techniques. The specific peritoneal dialysis-related difficulties reported are : difficulties in management of follow-up care and rehabilitation, the fear of insufficient purification and the difficulties related to the dialysis catheter. Concerning home hemodialysis, the barriers concern fear of autopunction and the need for a third party. This study helps to identify the representations of nephrologists on the major obstacles to the development of home dialysis to develop lines of thought for its promotion, both in terms of training, institutional acknowledgement, and the necessary regulatory evolution.

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Effects of A Comprehensive Predialysis Education Program on the Home Dialysis Therapies: A Retrospective Cohort Study

Abstract: Comprehensive patient education improves the choice and prevalence of HoD therapies. We further find that 3 sessions of CPE may provide needed resources for the large majority of subjects for adequate decision-making.

Cited by 28 publications

References 17 publications

What do the US advanced kidney disease patients want? Comprehensive pre-ESRD Patient Education (CPE) and choice of dialysis modality

What do the US advanced kidney disease patients want? Comprehensive pre-ESRD Patient Education (CPE) and choice of dialysis modality

Home run—results of a chronic kidney disease Telemedicine Patient Education Study

Home dialysis : what are the barriers . A French nephrologist survey

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