Advanced Practice Nurses in Nephrology

Easom, Andrea; Allbritton, Glenna

doi:10.1053/jarr.2000.8121

Cited by 8 publications

(5 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the United Kingdom and United States, nurse practitioners or physician assistants, who have completed advanced education and training in the diagnosis and management of dialysis patients, serve as physician extenders in the dialysis units. 11,12 Additionally, the balance between human resources and geographic factors may influence PDC patterns. In Australia and New Zealand, for instance, many renal centers provide health care services at associated satellite HD facilities in vast outlying areas of the country, and it may be difficult to constantly allocate or frequently dispatch physicians to these remote HD units.…”

Section: Discussionmentioning

confidence: 99%

Associations of Frequency and Duration of Patient-Doctor Contact in Hemodialysis Facilities with Mortality

Kawaguchi

Karaboyas

Robinson

et al. 2013

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

It is unknown whether regular patient-doctor contact (PDC) contributes to better outcomes for patients undergoing hemodialysis. Here, we analyzed the associations between frequency and duration of PDC during hemodialysis treatments with clinical outcomes among 24,498 patients from 778 facilities in the international Dialysis Outcomes and Practice Patterns Study (DOPPS). The typical facility PDC frequency, estimated by facility personnel, was high (more than once per week) for 55% of facilities, intermediate (once per week) for 24%, and low (less than once per week) for 21%. The mean 6 SD estimated duration of a typical interaction between patient and physician was 7.765.6 minutes. PDC frequency and duration varied across DOPPS phases and countries; the proportion of facilities with high PDC frequency was 17% in the United States and 73% across the other countries. Compared with high PDC frequency, the adjusted hazard ratio (HR) for all-cause mortality was 1.06 (95% confidence interval [CI], 0.96 to 1.17) for intermediate PDC frequency and 1.11 (95% CI, 1.01 to 1.23) for low PDC frequency (P=0.03 for trend). Furthermore, each 5-minutes-shorter duration of PDC was associated with a 5% higher risk for death, on average (HR, 1.05; 95% CI, 1.01 to 1.09), adjusted for PDC frequency and other covariates. Multivariable analyses also suggested modest inverse associations between both PDC frequency and duration with hospitalization but not with kidney transplantation. Taken together, these results suggest that policies supporting more frequent and longer duration of PDC may improve patient outcomes in hemodialysis.

show abstract

Section: Discussionmentioning

confidence: 99%

Associations of Frequency and Duration of Patient-Doctor Contact in Hemodialysis Facilities with Mortality

Kawaguchi

Karaboyas

Robinson

et al. 2013

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…A caseload of between 120 and 160 patients was deemed to be appropriate across a maximum of 2 to 3 outpatient dialysis clinics to test the model. In our proposed model, the specific tasks assigned to the case manager include: (1) assessment of new admis-sions together with the identification of case management needs based on nursing and risk assessments; (2) review urea kinetic modeling on a monthly basis and assist in appropriate prescription adjustment; (3) assist nursing staff with the management and application of treatment algorithms for metabolic bone disease and anemia; (4) review access flow testing results and track vascular access management; (5) review dry weight trends to minimize complications from congestive heart failure; (6) track hospitalizations and look for ways to reduce preventable hospital days; review and update vaccination status; (7) analyze continuous quality improvement trends in concert with the clinic manager and medical director; (8) establish and maintain collaborative relationships with physicians, managed care organization case managers and hospitals; and (9) provide educational support to nursing and patient care staff.…”

Section: Hypothesismentioning

confidence: 99%

“…Application of a case manager model in the outpatient hemodialysis setting offers the opportunity to improve outcomes in this resource‐depleted arena. Case managers augment the services of registered nurses and of physicians with a focus on improving continuous quality improvement indices 4–8 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A case management model to improve hemodialysis outpatient outcomes

Steele

Hamilton

Arnaout

2007

Hemodialysis International

View full text Add to dashboard Cite

Optimal outpatient dialysis care is often difficult to achieve and a case management model to augment conventionally applied nursing and physician resources focusing on continuous quality improvement presents a possible solution to improving outcomes in this setting. We applied this model to patients followed by our physician group. Continuous quality improvement data generated from the dialysis unit database were used to analyze outcomes in patients enrolled in this model. Data from the cohort of patients followed in 2003 served as the reference source for comparative purposes. The nurse case manager assumed responsibility during the second quarter of 2004. Comparing outcomes data from 2005 with data from 2003, we were able to achieve a 3.12% improvement in the annualized mean percent crude mortality per 100 patient years (p<0.003). There was a 3.46-day trend to improvement in patient hospital days per year (p<0.06). The percentage of catheters used as primary access decreased by 9.59% (p<0.025), and the percentage of patients meeting an eKdrt/V goal > or =1.2 increased by 15.33% to 92.37% (p<0.001). These data appear to support the utility of a case manager model in our system.

show abstract

“…Recent assessments suggest that a 28% increase in the number of nephrologists will be required by 2010 (2), but current trends suggest little or no annual growth in the number of nephrologists. More significantly, well‐trained registered nurses who can perform in‐center hemodialysis (HD) are decreasing in number—a subject that has received much attention recently (3–8). In all nations, economic resources are strained by the increasing cost of health care, and it can be anticipated that financial remuneration for ESRD services will not increase sufficiently to offset the costs for more personnel and equipment.…”

mentioning

confidence: 99%

A Time for Rediscovery: Chronic Hemofiltration for End‐Stage Renal Disease

McCarthy

Moran

Posen

et al. 2003

Seminars in Dialysis

View full text Add to dashboard Cite

Provision of maintenance renal replacement therapy (MRRT) is becoming increasingly challenging. The number of patients requiring MRRT is growing rapidly, while the number of nephrologists, nurses, and other staff available to provide therapy is not increasing at a similar rate. Patients are now older and have more comorbid conditions, which magnifies the complexity of their RRT and makes it increasingly difficult to maintain the quality of care within the limitations of constrained economic resources. The two most commonly used MRRTs are hemodialysis (HD) and peritoneal dialysis (PD). A third modality of MRRT, hemofiltration, is not currently in widespread use in North America. In hemofiltration, plasma is filtered through a highly permeable, biocompatible synthetic membrane and waste products are removed by convection and solvent drag as the filtrate moves across the membrane. Hemofiltration equipment constantly monitors the rate of plasma removal and administers a sterile, nonpyrogenic replacement solution at an appropriate rate to replace the waste-laden ultrafiltrate and avoid vdume depletion in the patient. Hemofiltration may offer some potential clinical advantages to the MRRT patient, including better hemodynamic and cardiovascular stability, enhanced removal of middle molecular weight toxins, increased comfort, and therapy preference. Some reports indicate possible reduced morbidity and mortality and reduced risk of bacterial contamination and inflammation as a result of the use of sterile, ultrapure replacement fluids. Chronic hemofiltration is a relatively simple MRRT option that may offer significant benefits for many patients who have end-stage renal disease (ESRD) and deserves closer consideration for these patients.

show abstract

Advanced Practice Nurses in Nephrology

Cited by 8 publications

References 8 publications

Associations of Frequency and Duration of Patient-Doctor Contact in Hemodialysis Facilities with Mortality

Associations of Frequency and Duration of Patient-Doctor Contact in Hemodialysis Facilities with Mortality

A case management model to improve hemodialysis outpatient outcomes

A Time for Rediscovery: Chronic Hemofiltration for End‐Stage Renal Disease

Contact Info

Product

Resources

About