Establishment of a renal supportive care program: Experience from a rural community hospital in Taiwan

Chao, Chia‐Ter; Tsai, Pi‐Ru; Shih, Chiaho; Hsu, Su-Hsuan; Hung, Yu‐Chien; Lai, Chun-Fu; Ueng, Ruey-Hsiuang; Chan, Ding‐Cheng; Hwang, Juey‐Jen; Huang, Sheng‐Jean

doi:10.1016/j.jfma.2015.12.009

Cited by 12 publications

(13 citation statements)

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“…Still, our results serve to inform clinical and costeffectiveness evaluations of supportive care for patients with advanced kidney disease. Despite analogous models of care implemented in the United States, 34,35 the United Kingdom, 27 Canada, 9 Taiwan, 36 and elsewhere in Australia, 37 evidence of the economic performance of such models remains a major knowledge gap and a hindrance on their implementation. 22 This is a concern especially in North America where CKD prevalence 38 and dialysis rates per million population 21 are higher than in Australia.…”

Section: Discussionmentioning

confidence: 99%

Utilization and Costs of Health Care in a Kidney Supportive Care Program

et al. 2019

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Kidney supportive care (KSC) is a patient-centered model of multidisciplinary care designed for patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Our goal was to characterize the types, frequencies, and costs of services accessed by patients enrolled in a KSC program. We analyzed health care utilization data prospectively collected from 102 patients who enrolled in the KSC program during the first 52 weeks of its existence. The data comprised program appointments, emergency department presentations, ambulance service use, outpatient visits, inpatient episodes, and dialysis treatments made within the Brisbane area of Metro North. Costs of resource use were estimated using Queensland Health funding principles and guidelines. Analyses included descriptive statistics, correlations, and multivariate regressions. During the median program participation of 22 weeks, patients had 3975 contacts with health care, with the total value of services amounting to nearly A$3 million. Dialysis treatments accounted for 70% of visits and 49% of costs. Patients receiving dialysis had higher utilization of outpatient services and associated cost, compared to patients who were not dialyzed. The presence of diabetes and the choice of conservative pathway were both predictors of higher frequency and cost of services. Longer program participation was associated with lower weekly utilization and cost. The program attracted patients representing various characteristics, pathways, needs, and outcomes. Exploring these patterns will enable better understanding of the patient population and improved service planning, in KSC and similar programs that aim to comprehensively address the needs of patients with advanced CKD and ESKD.

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Section: Discussionmentioning

confidence: 99%

Utilization and Costs of Health Care in a Kidney Supportive Care Program

et al. 2019

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“…This lack of proper RSC education might be related to the failure of identifying potential candidates, a low interest for specific topics within RSC, or the poor efficacy of existing educational techniques (Chung et al, 2016). Socio-cultural and geographic disparities also play a role in influencing the outcomes of RSC education (Chao et al, 2016b). Consequently, a comprehensive survey of the attitude, the knowledge, and the preferential issues for RSC among practitioners and their affiliated staffs is needed to optimize the educational outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The situation is particularly serious in Taiwan, largely due to the lack of investigations into relevant obstacles. We previously established a local RSC program within a rural community in Taiwan (Chao et al, 2016b). In such program, we select suitable candidates based on a validated rating scale, and harness a 3-step and 4-phase protocol to provide RSC to these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Those who agree to RSC receive the same care as they do in earlier stages of CKD, with particular emphasis on symptomatic and holistic care (Chao et al, 2016b). There are significant geographical variations in the prevalence of RSC practice.…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of dialysis withdrawal was significantly lower in East Asia than it was in the US and European countries (Fissell et al, 2005). In Taiwan, nephrologists and other affiliated staff infrequently promote RSC, and dialysis withdrawal is only offered during exceptional circumstances (Chao et al, 2016b). The reason for this lower RSC adoption rate is currently unclear, and none of the existing studies evaluated the perception of RSC among healthcare personnel in Taiwan, despite its extremely high incidence and prevalence of ESRD.…”

Section: Introductionmentioning

confidence: 99%

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A nationwide survey of healthcare personnel’s attitude, knowledge, and interest toward renal supportive care in Taiwan

Tsai

Chao

Chang

et al. 2017

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BackgroundRenal supportive care (RSC) is an important option for elderly individuals reaching end-stage renal disease; however, the frequency of RSC practice is very low among Asian countries. We evaluated the attitude, the knowledge, and the preference for specific topics concerning RSC among participants who worked in different medical professions in Taiwan.MethodsA cross-sectional questionnaire-based survey was employed. Healthcare personnel (N = 598) who were involved in caring for end-stage renal disease patients at more than 40 facilities in Taiwan participated in this study. Participants were asked about their motivation for learning about RSC, the topics of RSC they were most and least interested in, their willingness to provide RSC, and to rate their knowledge and perceived importance of different topics.ResultsThe vast majority of respondents (81.9%) were self-motivated about RSC, among whom nephrologists (96.8%) and care facilitators (administrators/volunteers) (45%) exhibited the highest and the least motivation, respectively (p < 0.01). Overall, respondents indicated that they had adequate knowledge about the five pre-specified RSC topics between medical professions (p = 0.04). Medical professions and institutional size exerted significant influence on the willingness to provide RSC.ConclusionsOur results facilitate the understanding of the knowledge and attitude toward different RSC topics among varied medical professions, and can guide the design of RSC education content for healthcare personnel.

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