Patient-reported barriers and outcomes associated with poor glycaemic and blood pressure control in co-morbid diabetes and chronic kidney disease

A self-care process model for patients with chronic noncommunicable diseases

Self-care of patients with chronic noncommunicable diseases is an essential component of contemporary healthcare. The purpose of this paper is to present a novel self-care process model and place it in the broader context of professional care. The extended Event-driven Process Chain approach to process modelling was used, focusing on a detailed overview of sequences of events, connections and activities and other elements/building blocks. A self-care process model was designed. The model is divided into two parts. The first part represents the self-care process when patients are able to manage their symptoms and be independent. The second part includes the process when patients are unable to perform self-care and/or need professional support. By identifying the essential elements of this process and incorporating them into the patients' care process, we can ensure that professional support for self-care creates a dynamic balance in the patients' ecosystems. Patients with chronic noncommunicable diseases need to make timely decisions about individual aspects of their health and seek professional help. In this way, an optimal level of health and well-being of patients can be achieved. Focusing on the patients' self-care process could also reduce treatment costs and improve the quality of life of patients. The novel designed model of the process of self-care, with all its essential elements, can be supported by digital technology, especially in the decision-making process and needs to become an important part of healthcare and long-term care systems.

Patient Activation: The Cornerstone of Effective Self-Management in Chronic Kidney Disease?

The importance of patient activation (i.e., the knowledge, skills, and confidence one has in managing one's own healthcare) in people with long-term conditions, including kidney disease, is growing. Enabling and empowering patients to take a more active role in their health and healthcare is the focus of person-centred care. Patient activation is recognised as a key construct of self-management, as to effectively self-manage a long-term condition, it is required to enable individuals to actively participate in treatment decisions, prevent complications, and manage risk factors. Identifying an individual's level of activation can help guide and tailor care, and interventions aimed at increasing patient activation may improve patient engagement and health outcomes. In this review, we explore the concepts of patient activation and self-management, the relationship between patient activation and self-management, interventions aimed at improving these, and what these mean to people living with kidney disease.

Patient activation and its association with symptom burden and quality of life across the spectrum of chronic kidney disease stages in England

Background

The knowledge, skills, and confidence to manage one’s own health is termed patient activation and can be assessed using the Patient Activation Measure (PAM). This measure is increasingly recommended for use in chronic kidney disease (CKD), but there is a need to better understand patient activation within this population. This work aimed to explore the association of PAM with patient-reported outcomes, namely symptom burden and health-related quality of life (HRQoL), to understand the relationship between patient activation and outcomes which are of importance to people with CKD.

Methods

Non-dialysis, dialysis, and kidney transplant patients from 14 renal units across England completed a survey comprising questionnaires assessing patient activation, symptom burden, and HRQoL.

Latent class analysis (LCA) was used to determine HRQoL and symptom burden subgroups in the data. Multinomial logistic regression analyses were performed to investigate the associations between patient activation and symptom burden and HRQoL classes separately, adjusting for age, gender, ethnicity, deprivation and treatment modality.

Results

Three thousand thirteen participants (mean age 61.5 years, 61.8% males, and 47% haemodialysis) were included in the analysis. Patient activation was strongly associated with both the HRQoL and symptom burden classes identified, with highly activated patients more likely to report higher HRQoL (P = < 0.0001; OR 29.2, 95% CI 19.5–43.9) and fewer symptoms (P = < 0.0001; OR 25.9, 95% CI 16.8–40.2).

Conclusion

Lower activation levels are associated with a higher symptom burden and reduced HRQoL across the trajectory of CKD stages and treatment modalities. Therefore, targeted and holistic self-management support focussing on improving activation may have the potential to improve aspects of health experience which are valued by individuals living with kidney disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-022-02679-w.

Fatores associados à ativação de pacientes em hemodiálise

Objetivo: mensurar a ativação de pacientes em hemodiálise e determinar os fatores associados à ativação dessa população. Materiais e método: estudo exploratório, de caráter descritivo e corte transversal com 162 pacientes em tratamento hemodialítico no interior de Minas Gerais, Brasil. Os dados foram coletados de janeiro a abril de 2019, com instrumentos para avaliação sociodemográfica, socioeconômica e clínica e da escala Patient Activation Measure de 13 itens. A análise de dados foi realizada por estatística descritiva e regressão de Poisson com variância robusta. Resultados: a medida de ativação dos pacientes em hemodiálise variou de 39,4 a 90,7 pontos, em que a média é 60,85 + 15,57 pontos e a mediana 53,2 (IC: 58,4-63,3) pontos. Dos participantes, 52,5 % (n = 85) apresentavam baixa ativação, sendo que o menor quantitativo de pessoas (18,5 %, n = 30) se encontrava no nível 3. Foi associado à maior prevalência de alta ativação o fato de apresentar o nível superior de ensino e não necessitar de cuidador. Conclusões: embora as variáveis associadas à alta ativação não sejam modificadas pelos profissionais de saúde, conhecê-las permite inferir qual o perfil de pacientes em hemodiálise que necessitam de intervenções direcionadas ao aumento dos níveis de ativação.

Diabetes Self-Management Among Healthcare Providers in King Abdulaziz Medical City, Riyadh: A Cross-Sectional Pilot Study

Background Diabetes mellitus (DM), a chronic metabolic disease, is a rising global concern with significant social, economic, and health implications. Proper glycemic control is crucial to guarantee protection against these implications such as micro and macrovascular complications. To achieve proper glycemic control, patients' self-management is probably the most essential component, and the development of appropriate self-management behaviors which include medication adherence and lifestyle modifications improves the prognosis and the incidence of DM complications. Objective The aim of the study is to examine diabetes self-management and control of diabetic healthcare providers from different specialties working at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Design and setting This is a cross-sectional pilot study carried out in King Abdulaziz Medical City, Riyadh, Saudi Arabia, using a pre-validated self-administered questionnaire that was "Diabetes Self-Management Questionnaire" (DSMQ), which examined diabetes management and control within the last two months. The questionnaire was distributed to the healthcare providers of all specialties at the site of the study. Correlations and descriptive analyses were carried out using the Statistical Package for Social Science (SPSS) software version 23 (IBM Corp, Armonk, USA). Results The total number of participants was 370 healthcare providers (100% response rate). It was found that 26 (7%) of them had diabetes (92.3% of them with type 2 diabetes). The diabetic participants' mean age was 48.58±7.3 years old. 42.3% were applied medical sciences specialists, with 38.5% having years of experience between 16 to 20 years old. 26.3% were Saudi nationals. The mean HbA1c levels among diabetic patients were 6±1.03%, ranging between (5.1%-9%). There was a significant inverse relationship between each section's scores and total scores with the HbA1c levels (p-value<0.05). Total scores for adherence were significantly higher among the age group (51 to 60) (p-value=0.03) and physicians (p-value=0.035). Dietary control was significantly better among age group (51 to 60) (p-value=0.015), and type 2 diabetes (p-value=0.022). Physician contact was significantly higher in the age group (51 to 60) (p-value=0.027). Physical activity was significantly higher among physicians (p-value=0.030). Blood glucose monitoring was significantly better among the age group (above 60) (p-value=0.026), males (p-value=0.03), and physicians (p-value=0.039). Conclusion The findings suggest the glycemic control and adherence to treatment among diabetic healthcare providers in KAMC-Riyadh are adequate the findings suggest the glycemic control and adherence to treatment among diabetic healthcare providers in KAMC-Riyadh are adequate. Future studies with an adequate sample size are essential to assess diabetes self-management and identify if there is any obstacle toward better compliance in healthcare providers.

Determinants of patient activation and its association with cardiovascular disease risk in chronic kidney disease: A cross-sectional study

Background

Patient activation describes the knowledge, skills and confidence in managing one's own health. Promoting patient activation is being prioritized to reduce costs and adverse outcomes such as cardiovascular disease (CVD). The increasing prevalence of chronic kidney disease (CKD) presents a need to understand the characteristics that influence patient activation and the effect on health outcomes.

Design

Cross‐sectional study.

Setting and participants

Patients with non‐dialysis CKD recruited from 14 sites (general nephrology and primary care) in England, UK.

Outcome measures

Patient activation was measured using the PAM‐13. Demographic and health‐related variables, self‐reported symptom burden, health‐related quality of life (HRQOL), socioeconomic status (SES), were assessed as determinants of patient activation. Major CVD risk factors included hypertension, dyslipidaemia, obesity and hyperkalaemia.

Results

743 patients were included (eGFR: 32.3 (_SD17.1) mL/min/1.73 m², age 67.8 (_SD13.9) years, 68% male). The mean PAM score was 55.1 (_SD14.4)/100. Most patients (60%) had low activation. Those with low activation were older (P<.001), had lower eGFR (P = .004), greater number of comorbidities (P = .026) and lower haemoglobin (P = .025). Patients with low activation had a 17% greater number of CVD risk factors (P < .001). Risk factors in those with low activation were being older (P < .001) and having diabetes (P < .001).

Conclusion

This study showed that only a minority of CKD patients are activated for self‐management. Our findings help better understand the level of activation in these patients, particularly older individuals with multimorbidity, and further the knowledge regarding the characteristics that influence activation.

Patient or Public Contribution

Patients were involved in the design of main study.

Ativação do paciente com diagnóstico de doença renal crônica: uma revisão integrativa

Objetivo: Estabelecer a medida de ativação de pacientes com doença renal crônica e seus fatores associados. Metodologia: Revisão integrativa de literatura realizada nas seguintes bases de dados: Pubmed, Lilacs, Scielo, Scopus, Science Direct e Insignia Health. Foram utilizados os descritores: Patient Activation, Nephrology, Kidney e Renal Insufficiency, Chronic e seus correspondentes em português e espanhol e os operadores booleanos AND e OR. Não foi utilizado filtro de data para as buscas. Nove manuscritos compuseram a amostra final desta revisão. Resultados: A média do escore de ativação variou entre 51±10 e 65,02±16 pontos, com o predomínio de pessoas com alta ativação (níveis 3 e 4). A ativação do paciente foi associada a múltiplas variáveis, entre elas a idade, condição socioeconômica, escolaridade e carga de sintomas. Conclusões: Conhecer o nível de ativação dos pacientes e os fatores associados a ele direciona a atuação do profissional de saúde para obtenção e/ou manutenção da alta ativação.

Measuring Patient Activation as Part of Kidney Disease Policy: Are We There Yet?

Optimal care occurs when patients possess the skills, knowledge, and confidence needed to effectively manage their health. Promoting such patient activation in kidney disease care is increasingly being prioritized, and patient activation has recently emerged as central to kidney disease legislative policy in the United States. Two options of the Centers for Medicare and Medicaid Services Kidney Care Choices model-the Kidney Care First option and the Comprehensive Kidney Care Contracting option-now include patient activation as a quality metric; both models specifically name the patient activation measure (PAM) as the patient-reported outcome to use when assessing activation in kidney disease. Because nephrology practices participating in these models will receive capitated payments according to changes in patients' PAM scores, it is time to more critically evaluate this measure as it applies to patients with kidney disease. In this review, we raise important issues related to the PAM's applicability to kidney health, review and summarize existing literature that applies this measure to patients with kidney disease, and outline key elements to consider when implementing the PAM into practice and policy. Our aim is to spur further dialogue regarding how to assess and address patient activation in kidney disease to facilitate best practices for supporting patients in the successful management of their kidney health.

Rate of uncontrolled blood pressure and its associated factors in patients with predialysis chronic kidney disease in Bali, Indonesia

Purpose

Hypertension is a key determinant for the development and progression of chronic kidney disease (CKD). The purpose of this study is to assess the rate of uncontrolled blood pressure (BP) and identify its associated factors in patients with predialysis CKD in Bali, Indonesia.

Design/methodology/approach

A cross-sectional study was conducted among 165 patients who attended the nephrology clinic in a central public hospital in Bali. Data were obtained by measuring BP at threshold 130/80 mmHg, as well as collected through standardized questionnaires. Univariate analysis was done using Chi-square test, and multivariate analyses were carried out using multiple logistic regression.

Findings

A total of 165 patients (111 males and 54 females) with predialysis CKD participated in this study. About 64% of the participants had uncontrolled BP. In multiple logistic regression, all selected variables significantly explained 63.2% of the variance in uncontrolled BP. However, low physical activity (odds ratio [OR] = 24.287, 95% confidence interval [CI]: 3.114–189.445), unhealthy dietary pattern (OR = 10.153, 95% CI: 2.770–37.210), as well as perceived moderate stress (OR = 4.365, 95% CI: 1.024-18.609) and high stress (OR = 10.978, 95% CI: 2.602–46.312) were significantly associated with uncontrolled BP.

Research limitations/implications

The study findings provide evidence for health care providers to improve BP control among patients with predialysis CKD.

Originality/value

Controlling BP among patients with predialysis CKD was poor. Lifestyle modification and stress management are keys to improving BP control.