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Uğurlu Z, Kav S, Eler ÇÖ, Kaya S, Korkmaz Y. Health literacy in older adults receiving hemodialysis in Turkey: A cross-sectional study. Ther Apher Dial 2024; 28:380-389. [PMID: 38163856 DOI: 10.1111/1744-9987.14102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/10/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION This study aimed to determine the health literacy level and related factors of older adults receiving hemodialysis treatment. METHODS A cross-sectional study was conducted at the five dialysis centers, using the information form and Turkish Health Literacy Survey-32 (THLS-32). A total of 336 older adults receiving hemodialysis treatment participated. RESULTS The general health literacy score was found to be 25.69 ± 14.47. Based on the health literacy assessment scores, 62.5% of the participants were in the category of inadequate and limited level of health literacy. The lower level of education, perceived health status, income, and getting help in reading and writing were statistically significant predictors of the health literacy score. CONCLUSION The health literacy of older adults receiving hemodialysis treatment was inadequate and limited. Findings of this study emphasize the importance of integrating health literacy assessment in clinical care settings and supporting the health literacy of older adults receiving hemodialysis treatment.
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Affiliation(s)
- Ziyafet Uğurlu
- Faculty of Health Sciences, Department of Nursing, Baskent University, Ankara, Turkey
| | - Sultan Kav
- Faculty of Health Sciences, Department of Nursing, Baskent University, Ankara, Turkey
| | - Çiğdem Özdemir Eler
- Vocational Health School, Dialysis Program, Baskent University, Ankara, Turkey
| | - Semiha Kaya
- Umitkoy Dialysis Center Director, Baskent University, Ankara, Turkey
| | - Yasemin Korkmaz
- Cigdem Dialysis Center, Baskent University Hospital, Ankara, Turkey
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2
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Akbal Y, Nural N. The Effect of Health Literacy on Patient Outcomes in Stage 3b-4 Pre-Dialysis Patients: A Semi-Experimental Study. J Community Health Nurs 2023; 40:242-254. [PMID: 36999668 DOI: 10.1080/07370016.2023.2191593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
This study was conducted to investigate the effect of health literacy on patient outcomes in pre-dialysis patients. A semi-experimental study. The study was conducted with 45 intervention and 45 control patients with glomerular filtration rates between 15-44ml/min/1.73m2. The adequate health literacy of the patients in the intervention group increased from 2.2% to 31.1%. Increased health literacy led to a significant decrease in systolic and diastolic blood pressure values and the severity of symptoms. The study showed that increased health literacy in pre-dialysis patients improves patient outcomes. Nursing care is needed in pre-dialysis.
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Affiliation(s)
- Yağmur Akbal
- Faculty of Health Sciences, Department of Nursing, Department of Internal Medicine Nursing, Recep Tayyip Erdogan University, Rize, Turkey
| | - Nesrin Nural
- Faculty of Health Sciences, Department of Nursing, Department of Internal Medicine Nursing, Prof. Karadeniz Technical University, Trabzon, Turkey
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Torres-Gutiérrez M, Burgos-Camacho V, Caamaño-Jaraba JP, Lozano-Suárez N, García-López A, Girón-Luque F. Prevalence and Modifiable Factors for Holistic Non-Adherence in Renal Transplant Patients: A Cross-Sectional Study. Patient Prefer Adherence 2023; 17:2201-2213. [PMID: 37701427 PMCID: PMC10493132 DOI: 10.2147/ppa.s419324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/12/2023] [Indexed: 09/14/2023] Open
Abstract
Introduction In renal transplant recipients, compliance with medical therapy is vital. Non-adherence is considered a risk factor for worst outcomes in kidney recipients, with attributed outcomes of 64% for graft loss and 80% for late acute rejection. Most literature defines adherence as self-based immunosuppression compliance but does not consider other relevant factors such as consult and procedure compliance. Therefore, this study aims to describe adherence prevalence in kidney transplant recipients and the factors related to non-adherence. Methods This cross-sectional study included 1030 renal transplant patients followed by Colombiana de Trasplantes between January 2019 and July 2021. Sociodemographic and clinical variables were obtained based on clinical records. The mental-health group diagnosed holistic adherence in a semi-structured interview. The diagnosis considered medication intake failure, frequency and number of failures to medical controls or other procedures, suspicious non-adherence behaviors, and serum levels of immunosuppressants. A bivariate followed a descriptive analysis, and a forward logistic regression was performed for non-adherence. Results Patients had a median of 47 years, and 58.1% were male. Non-adherence was presented in 30.7% of patients. The non-adherence patients were younger, with a higher prevalence of males, single, divided transplant care, had a longer time after transplantation, psychopathological diagnosis, and more reinforcement education by only nursing. Older age and multidisciplinary reinforcement education were protective factors. On the other hand, poor social support, psychopathology diagnosis, and longer time after transplant presented as non-adherence risk factors. Conclusion Holistic non-adherence was diagnosed in approximately one-third of renal transplant recipients. Its definition included more than just medication non-compliance and could identify more non-adherent patients. Notably, there is a need to consider the related factors in the health follow-up and encourage future research in modifiable factor interventions aiming to increase adherence and achieve better outcomes for renal transplant patients.
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Affiliation(s)
| | | | | | | | - Andrea García-López
- Department of Transplant Research, Colombiana de Trasplantes, Bogotá, Colombia
| | - Fernando Girón-Luque
- Department of Transplant Research, Colombiana de Trasplantes, Bogotá, Colombia
- Department of Transplant Surgery, Colombiana de Trasplantes, Bogotá, Colombia
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Toapanta N, Salas-Gama K, Pantoja PE, Soler MJ. The role of low health literacy in shared treatment decision-making in patients with kidney failure. Clin Kidney J 2023; 16:i4-i11. [PMID: 37711638 PMCID: PMC10497376 DOI: 10.1093/ckj/sfad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Indexed: 09/16/2023] Open
Abstract
The classic paternalist medicine in nephrology has been modified to a shared decision-making model that clearly offers a benefit in patients with kidney disease. One of the cornerstones of shared treatment decision in patients with kidney failure is the understanding of kidney disease. As kidney disease is silent until advanced stages and is also an entity with a complex pathophysiology with little knowledge in the general population, its presence and understanding are difficult for most people. Health literacy (HL) plays a crucial role in the care of patients with kidney disease and the shared treatment decision. Limited HL has been associated with inefficient use of health services, non-compliance of medications, worse quality of life and increased mortality. In this review, we will address the importance of low HL in nephrology in terms of diagnosis, measurement, its effect on shared decision-making and how to increase it in people with kidney disease.
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Affiliation(s)
- Néstor Toapanta
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Karla Salas-Gama
- Quality, Process and Innovation Direction, Vall d'Hebron University Hospital, Barcelona, Spain
- Health Services Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital University, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- PhD candidate at the Methodology of Biomedical Research and Public Health program, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Percy Efrain Pantoja
- Quality, Process and Innovation Direction, Vall d'Hebron University Hospital, Barcelona, Spain
- Health Services Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital University, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - María José Soler
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain
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Knicely DH, Rinaldi K, Snow S, Cervantes CE, Choi MJ, Jaar BG, Thavarajah S. The ABCs of Kidney Disease: Knowledge Retention and Healthcare Involvement. J Patient Exp 2021; 8:23743735211065285. [PMID: 34901415 PMCID: PMC8664299 DOI: 10.1177/23743735211065285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Low health literacy in the chronic kidney disease population results in lower rates of pre-dialysis preparation and understanding of management to slow progression. The ABCs of Kidney Disease education class provided education in a more consistent manner outside of routine office visits. We aimed to study whether a structured education program would increase kidney disease-specific knowledge and healthcare involvement. Knowledge retention at least 6 months after the class assessed by the Kidney Disease Knowledge Surveys (KiKS) and healthcare involvement based on surveys sent to referring providers were found to have increased. Incorporation of a structured education program would be important for providers to improve long-term knowledge and lead to greater healthcare involvement. Providing an education class outside of the routine office visits will provide a greater impact on health literacy.
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Affiliation(s)
- Daphne H Knicely
- Department of Medicine/Division of Nephrology & Center for Immunity, Inflammation & Regenerative Medicine, University of Virginia School of Medicine, Fishersville, VA, USA
| | - Kristina Rinaldi
- Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Shani Snow
- Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Carmen Elena Cervantes
- Division of Nephrology/Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J Choi
- MedStar Georgetown University Hospital, Washington, DC, USA
| | - Bernard G Jaar
- Division of Nephrology/Department of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sumeska Thavarajah
- Division of Nephrology/Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Wei CJ, Shih CL, Hsu YJ, Chen YC, Yeh JZ, Shih JH, Chiu CH. Development and application of a chronic kidney disease-specific health literacy, knowledge and disease awareness assessment tool for patients with chronic kidney disease in Taiwan. BMJ Open 2021; 11:e052597. [PMID: 34635527 PMCID: PMC8506855 DOI: 10.1136/bmjopen-2021-052597] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study aims to develop an assessment tool for health literacy and knowledge specific to chronic kidney disease (CKD) for use in examining the associations between health literacy, disease-specific knowledge and disease awareness among patients with CKD in Taiwan. DESIGN An assessment tool in Mandarin and Taiwanese was developed based on patient input, panel discussions with experts and a literature review, and checked for validity and reliability in a pilot test. Formal data were collected through population-based sampling with a set quota according to region and hospital accreditation level. Cross-sectional data were collected to confirm the reliability and validity of the assessment tool. Levels of health literacy, disease knowledge, and disease awareness were then reported and analysed. SETTING Sample hospitals included 10 medical centres, 18 regional hospitals and 15 local hospitals in Taiwan. Researchers were granted Internal Review Board approval and obtained agreement to collect data in all study settings. PARTICIPANTS Patients at least 20 years old who had been diagnosed with CKD of any stage were eligible to participate. The formal assessment collected 1155 valid questionnaires, yielding an 87.3% response rate. The mean age of participants was 67.48 years (SD=12.87, range 22-98), while 484 (41.95%) were female and 78% were aware they had CKD. RESULTS The self-devised instrument proved to have excellent reliability and validity. Use of the instrument in the main study showed that CKD-specific health literacy was significantly associated with age (β=-0.33, p<0.00), educational attainment and disease awareness (β=0.13, p<0.00). CKD-specific knowledge was also significantly associated with age (β=-0.18, p<0.00), educational attainment and disease awareness (β=0.19, p<0.00). CONCLUSIONS This CKD-specific health literacy and knowledge assessment tool developed for Mandarin and Taiwanese-speaking patients is reliable and well validated. Patients with CKD who are aware of and understand their disease performed better in the assessment.
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Affiliation(s)
- Chung-Jen Wei
- Department of Public Health, Fu Jen Catholic University, Taipei, Taiwan
| | - Chung-Liang Shih
- Deputy Minister Office, Executive Yuan Republic of China Ministry of Health and Welfare, Taipei, Taiwan
| | - Yu-Juei Hsu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yin-Cheng Chen
- Division of Nephrology, Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Jue-Zong Yeh
- Department of Pharmacy, Tri-Service General Hospital, Taipei, Taiwan
| | - Jia-Hui Shih
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Chiung-Hsuan Chiu
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
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Urstad KH, Wahl AK, Moum T, Engebretsen E, Andersen MH. Renal recipients' knowledge and self-efficacy during first year after implementing an evidence based educational intervention as routine care at the transplantation clinic. BMC Nephrol 2021; 22:265. [PMID: 34266414 PMCID: PMC8284003 DOI: 10.1186/s12882-021-02468-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/30/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Following an implementation plan based on dynamic dialogue between researchers and clinicians, this study implemented an evidence-based patient education program (tested in an RCT) into routine care at a clinical transplant center. The aim of this study was to investigate renal recipients' knowledge and self-efficacy during first year the after the intervention was provided in an everyday life setting. METHODS The study has a longitudinal design. The sample consisted of 196 renal recipients. Measurement points were 5 days (baseline), 2 months (T1), 6 months (T2), and one-year post transplantation (T3). Outcome measures were post-transplant knowledge, self-efficacy, and self-perceived general health. RESULTS No statistically significant changes were found from baseline to T1, T2, and T3. Participants' levels of knowledge and self-efficacy were high prior to the education program and did not change throughout the first year post transplantation. CONCLUSION Renal recipients self-efficacy and insight in post-transplant aspects seem to be more robust when admitted to the hospital for transplantation compared to baseline observations in the RCT study. This may explain why the implemented educational intervention did not lead to the same positive increase in outcome measures as in the RCT. This study supports that replicating clinical interventions in real-life settings may provide different results compared to results from RCT's. In order to gain a complete picture of the impacts of an implemented intervention, it is vital also to evaluate results after implementing findings from RCT-studies into everyday practice.
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Affiliation(s)
- Kristin Hjorthaug Urstad
- Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, 4036, Stavanger, Norway.
| | - Astrid Klopstad Wahl
- Faculty of Medicine, Department of Health Sciences, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Moum
- Faculty of Medicine, Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Eivind Engebretsen
- Faculty of Medicine, Department of Health Sciences, University of Oslo, Oslo, Norway
| | - Marit Helen Andersen
- Faculty of Medicine, Department of Health Sciences, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
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Boyer A, Begin Y, Dupont J, Rousseau-Gagnon M, Fernandez N, Demian M, Simonyan D, Agharazii M, Mac-Way F. Health literacy level in a various nephrology population from Québec: predialysis clinic, in-centre hemodialysis and home dialysis; a transversal monocentric observational study. BMC Nephrol 2021; 22:259. [PMID: 34243705 PMCID: PMC8272301 DOI: 10.1186/s12882-021-02464-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/04/2021] [Indexed: 03/06/2024] Open
Abstract
Background Health literacy refers to the ability of individuals to gain access to, use, and understand health information and services in order to maintain a good health. It is especially important in nephrology due to the complexity of chronic kidney disease (CKD). The present study sought to define health literacy levels in patients followed in predialysis clinic, in-center dialysis (ICHD), peritoneal dialysis (PD) and home hemodialysis (HHD). Methods This transversal monocentric observational study analysed 363 patients between October 2016 and April 2017. The Brief Health Literacy Screen (BHLS) and the Health Literacy Questionnaire (HLQ) were used to measure health literacy. Multivariate linear regressions were used to compare the mean scores on the BHLS and HLQ, across the four groups. Results Patients on PD had a significantly higher BHLS’score than patients on ICHD (p = 0.04). HLQ’s scores differed across the groups: patients on HHD (p = 0.01) and PD (p = 0.002) were more likely to feel understood by their healthcare providers. Compared to ICHD, patients on HHD were more likely to have sufficient information to manage their health (p = 0.02), and patients in the predialysis clinic were more likely to report high abilities for health information appraisal (p < 0.001). Conclusion In a monocentric study, there is a significant proportion of CKD patients, especially in predialysis clinic and in-centre hemodialysis, with limited health literacy. Patients on home dialysis (HHD and PD) had a higher level of health literacy compared to the other groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02464-1.
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Affiliation(s)
- Annabel Boyer
- CHU de Queébec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, QC, Canada. .,Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada. .,Centre Universitaire des Maladies Rénales, CHU de Caen, 14033, Caen Cedex 9, France.
| | - Yannick Begin
- CHU de Queébec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, QC, Canada.,Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Julie Dupont
- Nurse practitioner, CHU de Québec-Université Laval Nursing Department, L'Hôtel-Dieu de Québec Hospital, Québec, QC, Canada
| | - Mathieu Rousseau-Gagnon
- CHU de Queébec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, QC, Canada.,Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Nicolas Fernandez
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Québec, Canada
| | - Maryam Demian
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - David Simonyan
- Clinical and Evaluative Research Platform, CHU de Québec-Université Laval Research Center, Québec, Canada
| | - Mohsen Agharazii
- CHU de Queébec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, QC, Canada.,Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Fabrice Mac-Way
- CHU de Queébec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, QC, Canada.,Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
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Pelayo Alonso R, Martínez Álvarez P, Cagigas Villoslada MJ, Cobo Sánchez JL, Palacio Cornejo CM. Grado de incumplimiento terapéutico en función del nivel de alfabetización en salud en pacientes en hemodiálisis. ENFERMERÍA NEFROLÓGICA 2021. [DOI: 10.37551/s2254-28842021016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: El paciente en hemodiálisis está sometido a un régimen terapéutico cuya adherencia contribuye a disminuir la aparición de complicaciones asociadas mejorando la morbimortalidad. El incumplimiento terapéutico es un problema prevalente en la práctica clínica. Bajos niveles de alfabetización en salud se relacionan con falta de autocuidados, errores en la toma de medicaciones y dificultad para entender instrucciones, lo que trae consigo una mayor tasa de incumplimiento terapéutico. Objetivo: Conocer el grado de incumplimiento terapéutico en función del grado de alfabetización en salud de los pacientes sometidos a hemodiálisis. Material y Método: Estudio prospectivo en 35 pacientes en programa de hemodiálisis. La alfabetización en salud se valoró con el cuestionario Health Literacy Survey European Union y el grado de incumplimiento terapéutico mediante la ganancia de peso interdialítica e indicadores analíticos, según recomendaciones de guías clínicas. Resultados: Los pacientes con nivel de alfabetización adecuada (≥34 puntos) presentaron menor incumplimiento terapéutico que pacientes con alfabetización inadecuada en relación a ganancia de peso interdialítica (78%vs 70%), potasio (67%vs56%), albúmina (83%vs72%) pero mayor IT con el fósforo (83,33%vs51,44%) – p<0,05 en todos los casos-. Conclusiones: Los pacientes con mayor nivel de alfabetización en salud tienen un menor grado de incumplimiento terapéutico, a excepción del fósforo, que es el parámetro con peor tasa de adherencia.
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Affiliation(s)
- Raquel Pelayo Alonso
- Servicio de Nefrología. Hospital Universitario Marqués de Valdecilla. Santander. España
| | | | | | - José Luis Cobo Sánchez
- Subdirección de Cuidados. Servicio Cántabro de Salud. Santander, España. Escuela universitaria de Enfermería Clínica Mompía. Universidad Católica de Ávila. Mompía. España
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Rostoker G, Issad B, Fessi H, Massy ZA. Why and how should we promote home dialysis for patients with end-stage kidney disease during and after the coronavirus 2019 disease pandemic? A French perspective. J Nephrol 2021; 34:985-989. [PMID: 34061336 PMCID: PMC8167385 DOI: 10.1007/s40620-021-01061-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/03/2021] [Indexed: 02/07/2023]
Abstract
The health crisis induced by the pandemic of coronavirus 2019 disease (COVID-19) has had a major impact on dialysis patients in France. The incidence of infection with acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first wave of the COVID-19 epidemic was 3.3% among dialysis patients-13 times higher than in the general population. The corresponding mortality rate was high, reaching 21%. As of 19th April, 2021, the cumulative prevalence of SARS-CoV-2 infection in French dialysis patients was 14%. Convergent scientific data from France, Italy, the United Kingdom and Canada show that home dialysis reduces the risk of SARS-CoV-2 infection by a factor of at least two. Unfortunately, home dialysis in France is not sufficiently developed: the proportion of dialysis patients being treated at home is only 7%. The obstacles to the provision of home care for patients with end-stage kidney disease in France include (i) an unfavourable pricing policy for home haemodialysis and nurse visits for assisted peritoneal dialysis (PD), (ii) insufficient training in home dialysis for nephrologists, (iii) the small number of administrative authorizations for home dialysis programs, and (iv) a lack of structured, objective information on renal replacement therapies for patients with advanced chronic kidney disease (CKD). We propose a number of pragmatic initiatives that could be simultaneously enacted to improve the situation in three areas: (i) the provision of objective information on renal replacement therapies for patients with advanced CKD, (ii) wider authorization of home dialysis networks and (iii) price increases in favour of home dialysis procedures.
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Affiliation(s)
- Guy Rostoker
- Department of Nephrology and Dialysis, Hôpital Privé Claude Galien, Ramsay Santé, Quincy-sous-Sénart, France. .,Collège de Médecine des Hôpitaux de Paris, Paris, France.
| | - Belkacem Issad
- Peritoneal Dialysis Centre, Nephrology Department, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Hafedh Fessi
- Home Haemodialysis Unit, Nephrology and Dialysis Department, Hôpital Tenon AP-HP, Paris, France
| | - Ziad A Massy
- Nephrology Department, Hôpital Ambroise Paré, APHP, Boulogne; and INSERM Unit 1018, CESP, University Versailles-St Quentin, University Paris Saclay, Villejuif, France
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11
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Lin CC, Hwang SJ. Patient-Centered Self-Management in Patients with Chronic Kidney Disease: Challenges and Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9443. [PMID: 33339300 PMCID: PMC7766278 DOI: 10.3390/ijerph17249443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022]
Abstract
This review aims to identify attributes of patient-centered self-management (PCSM) in the current literature and explore its implementation in resolving patient obstacles in chronic kidney disease (CKD) treatment and management. A search of relevant articles and literature on PCSM, integrated care, and challenges of CKD management was conducted. Vital attributes of PCSM and current self-management interventions employed to resolve patient obstacles in CKD management were identified from inclusion studies. Findings affirm that PCSM strategies have positive effects on CKD management, but a lack of quality primary study, and long-term evidence presents the need for further development. Future research should focus on the development of a standardized and universal integrated PCSM model and a uniform system of data collection in the clinical setting. The difficulty of CKD management lies in how it is a comorbid and progressive disease. A pure biomedical approach is inadequate. Our review recommends that an integrated PCSM approach with health literacy and information technology intervention, which unifies and integrates patient education, can address the difficulties that are contributing to unsuccessful treatment outcomes. An integrated PCSM model should be implemented systematically and methodologically into future CKD management and health policies.
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Affiliation(s)
- Chiu-Chu Lin
- School of Nursing, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Taiwan Society of Nephrology, Taipei 10022, Taiwan
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12
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Kita Y, Machida S, Shibagaki Y, Sakurada T. Fact-finding survey on health literacy among Japanese predialysis chronic kidney disease patients: a multi-institutional cross-sectional study. Clin Exp Nephrol 2020; 25:224-230. [PMID: 33063230 DOI: 10.1007/s10157-020-01982-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Low health literacy (HL) has been associated with poor chronic disease management and adverse outcomes. However, reports on HL in predialysis chronic kidney disease (CKD) patients are limited in Japan. METHODS From August 2019 to February 2020, the European Health Literacy Survey (Japanese version) and a patient background survey (highest level of education, income, social activities, and exercise habit) were conducted on adult predialysis CKD patients. We compared clinical parameters in two groups according to the average HL score of a healthy Japanese population. In addition, a median value of 42 items was used as a cutoff for extracting CKD patient background factors associated with HL since HLS-EU-Q47 included five items related to physical activity and exercise. RESULTS Valid responses were received from 200 patients. Median general HL index was 25.2 points. The high-HL group (≥ 25.3 points) showed a low proportion of male (56.7% vs. 70.9%, p = 0.038), high social activities (69.1% vs. 48.5%, p = 0.003), and high exercise habit (36.1% vs. 13.6%, p < 0.001). In the multivariate analysis, social activity [OR (95% CI); 2.12 (1.16-3.89), p = 0.015] and exercise habit [OR (95% CI); 2.39 (1.16-4.90), p = 0.018] were extracted as the only significant variable. CONCLUSIONS HL in Japanese predialysis CKD patients was associated with high social activity and exercise habit.
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Affiliation(s)
- Yohei Kita
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Shinji Machida
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Tsutomu Sakurada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
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Verseput C, Piccoli GB. Eating Like a Rainbow: The Development of a Visual Aid for Nutritional Treatment of CKD Patients. A South African Project. Nutrients 2017; 9:nu9050435. [PMID: 28452932 PMCID: PMC5452165 DOI: 10.3390/nu9050435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/11/2017] [Accepted: 04/17/2017] [Indexed: 12/21/2022] Open
Abstract
Providing nutritional education for chronic kidney disease (CKD) patients in South Africa is complicated by several conditions: the population is composed of diverse ethnic groups, each with its own culture and food preferences; eleven languages are spoken and illiteracy is common in the lower socio-economic groups. Food preparation and storage are affected by the lack of electricity and refrigeration, and this contributes to a monotonous diet. In traditional African culture, two meals per day are often shared "from the pot", making portion control difficult. There is both under- and over-nutrition; late referral of CKD is common. Good quality protein intake is often insufficient and there are several misconceptions about protein sources. There is a low intake of vegetables and fruit, while daily sodium intake is high, averaging 10 g/day, mostly from discretionary sources. On this background, we would like to describe the development of a simplified, visual approach to the "renal diet", principally addressed to illiterate/non-English speaking CKD patients in Southern Africa, using illustrations to replace writing. This tool "Five steps to improve renal diet compliance", also called "Eating like a Rainbow", was developed to try to increase patients' understanding, and has so far only been informally validated by feedback from users. The interest of this study is based on underlining the feasibility of dietary education even in difficult populations, focusing attention on this fundamental issue of CKD care in particular in countries with limited access to chronic dialysis.
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Affiliation(s)
- Cecile Verseput
- RD Consultant Renal Dietitian, 6 Janet Street, Glenvista, Johannesburg 2091, South Africa.
| | - Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino, 10124 Torino, Italy.
- Nephrologie, Centre Hospitalier Le Mans, 72037 Le Mans, France.
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Moraes KL, Brasil VV, Oliveira GFD, Cordeiro JABL, Silva AMTC, Boaventura RP, Munari DB, Ribeiro Canhestro M. Functional health literacy and knowledge of renal patients on pre-dialytic treatment. Rev Bras Enferm 2017; 70:155-162. [PMID: 28226055 DOI: 10.1590/0034-7167-2015-0169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 09/01/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: to analyze the functional health literacy (FHL), i.e., understanding and knowledge about chronic renal disease of 60 patients in pre-dialytic treatment. METHOD: this is a cross-sectional study. FHL was measured by B-TOFHLA; and the knowledge, by questionnaire. Pearson correlation and Chi-square tests were carried out as well as linear regression models. RESULTS: all respondents presented inadequate FHL, and most showed insufficient knowledge about the disease and treatment. Low schooling was a predictive factor for worst FHL scores. Insufficient knowledge was related to age and compromised cognition. CONCLUSION: although association between predictive variables has not been found, limited capability to obtain and use health-related information and insufficient knowledge about their own condition and treatment can contribute to worse outcomes for CKD. Appropriate intervention strategies are necessary to deal with limited FHL and also greater knowledge and ability of professionals to deal with the matter.
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Affiliation(s)
- Katarinne Lima Moraes
- Universidade Federal de Goiás, Faculdade de Enfermagem, Programa de Pós-Graduação em Enfermagem. Goiânia-GO, Brasil
| | - Virginia Visconde Brasil
- Universidade Federal de Goiás, Faculdade de Enfermagem, Programa de Pós-Graduação em Enfermagem. Goiânia-GO, Brasil
| | | | | | | | - Rafaela Peres Boaventura
- Universidade Federal de Goiás, Faculdade de Enfermagem, Programa de Pós-Graduação em Enfermagem. Goiânia-GO, Brasil
| | - Denize Bouttelet Munari
- Universidade Federal de Goiás, Faculdade de Enfermagem, Programa de Pós-Graduação em Enfermagem. Goiânia-GO, Brasil
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Jain D, Green JA. Health literacy in kidney disease: Review of the literature and implications for clinical practice. World J Nephrol 2016; 5:147-151. [PMID: 26981438 PMCID: PMC4777785 DOI: 10.5527/wjn.v5.i2.147] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/18/2015] [Accepted: 01/29/2016] [Indexed: 02/06/2023] Open
Abstract
Health literacy is the capacity of an individual to understand information related to a disease in order to make an informed decision. In patients with kidney diseases, studies have reported increasing impact of limited health literacy on health outcomes. Our paper discusses current literature on health literacy in kidney diseases.
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Ladin K, Weiner DE. Better informing older patients with kidney failure in an era of patient-centered care. Am J Kidney Dis 2015; 65:372-4. [PMID: 25704042 DOI: 10.1053/j.ajkd.2015.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 12/29/2014] [Indexed: 11/11/2022]
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17
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Green JA, Cavanaugh KL. Understanding the influence of educational attainment on kidney health and opportunities for improved care. Adv Chronic Kidney Dis 2015; 22:24-30. [PMID: 25573509 DOI: 10.1053/j.ackd.2014.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 07/02/2014] [Accepted: 07/16/2014] [Indexed: 12/31/2022]
Abstract
Educational attainment is an important but often overlooked contributor to health outcomes in patients with kidney disease. Those with lower levels of education have an increased risk of ESRD, complications of peritoneal dialysis, worse transplant outcomes, and mortality. Mediators of these associations are poorly understood but involve a complex interplay between health knowledge, behaviors, and socioeconomic and psychosocial factors. Interventions targeting these aspects of care have the potential to reduce disparities related to educational attainment; however, few programs have been described that specifically address this issue. Future research efforts should not only systematically assess level of educational attainment but also report the differential impact of interventions across educational strata. In addition, routine measurement of health literacy may be useful to identify high-risk patients independent of years of schooling. A better understanding of the influence of educational attainment on kidney health provides an opportunity to improve the care and outcomes of vulnerable patients with kidney disease.
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Bear RA, Stockie S. Patient engagement and patient-centred care in the management of advanced chronic kidney disease and chronic kidney failure. Can J Kidney Health Dis 2014; 1:24. [PMID: 25780613 PMCID: PMC4349790 DOI: 10.1186/s40697-014-0024-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/17/2014] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The purpose of this article is to review the current status of patient-centred care (PCC) and patient engagement (PE) in the management of patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD), to identify some of the barriers that exist to the achievement of PCC and PE, and to describe how these barriers can be overcome. SOURCES OF INFORMATION The review is based on the professional experience of one of the authors (RB) as a Nephrologist and health care consultant, on the MBA thesis of one of the authors (SS) and on a review of pertinent internet-based information and published literature. FINDINGS Evidence exists that, currently, the care of patients with advanced CKD and ESRD is not fully patient-centred or fully supportive of PE. A number of barriers exist, including: conflict with other priorities; lack of training and fear of change; the unequal balance of power between patients and providers; physician culture and behaviour; the fee-for-service model of physician compensation; slow implementation of electronic health records; and, fear of accountability. These barriers can be overcome by committed leadership and the development of an information-based implementation plan. Established Renal Agencies in Canada appear interested in facilitating this work by collaborating in the development of a toolkit of recommended educational resources and preferred implementation practices for use by ESRD Programs. LIMITATIONS A limitation of this review is the absence of a substantial pre-existing literature on this topic. IMPLICATIONS Receiving care that is patient-centred and that promotes PE benefits patients with serious chronic diseases such as advanced CKD and ESRD. Considerable work is required by ESRD Programs to ensure that such care is provided. Canadian Renal Agencies can play an important role by ensuring that ESRD Programs have access to essential educational material and proven implementation approaches and that implementation successes are celebrated. In this area, enabling policies are required, as are clinical research studies focusing on the measurement of outcomes.
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