Effect of Information and Telephone-Guided Access to Community Support for People with Chronic Kidney Disease: Randomised Controlled Trial

Abstract

BackgroundImplementation of self-management support in traditional primary care settings has proved difficult, encouraging the development of alternative models which actively link to community resources. Chronic kidney disease (CKD) is a common condition usually diagnosed in the presence of other co-morbidities. This trial aimed to determine the effectiveness of an intervention to provide information and telephone-guided access to community support versus usual care for patients with stage 3 CKD.Methods and FindingsIn a pragmatic, two-arm, patient level randomised controlled trial 436 patients with a diagnosis of stage 3 CKD were recruited from 24 general practices in Greater Manchester. Patients were randomised to intervention (215) or usual care (221). Primary outcome measures were health related quality of life (EQ-5D health questionnaire), blood pressure control, and positive and active engagement in life (heiQ) at 6 months. At 6 months, mean health related quality of life was significantly higher for the intervention group (adjusted mean difference = 0.05; 95% CI = 0.01, 0.08) and blood pressure was controlled for a significantly greater proportion of patients in the intervention group (adjusted odds-ratio = 1.85; 95% CI = 1.25, 2.72). Patients did not differ significantly in positive and active engagement in life. The intervention group reported a reduction in costs compared with control.ConclusionsAn intervention to provide tailored information and telephone-guided access to community resources was associated with modest but significant improvements in health related quality of life and better maintenance of blood pressure control for patients with stage 3 CKD compared with usual care. However, further research is required to identify the mechanisms of action of the intervention.Trial RegistrationControlled-Trials.com ISRCTN45433299

Self-Management Program for People with Chronic Kidney Disease in Vietnam: A Pragmatic Randomised Controlled Trial

“…Previous studies of CKD self-management integration have examined nutrition (i.e., label reading, identification of food containing salt or protein) (Campbell, Ash, & Bauer, 2008;Chen et al, 2011;Kazawa & Moriyama, 2013), lifestyle modifications (Chen et al, 2011;Joboshi & Oka, 2016;Kazawa & Moriyama, 2013), self-monitoring (Kazawa & Moriyama, 2013;Lin et al, 2013), and making efforts to adjust to living with CKD (Blakeman et al, 2014).…”

“…Several CKD self-management studies have used problem-solving skills to assist patients (Blakeman et al, 2014;Joboshi & Oka, 2016;Lin et al, 2013;Teng, Yen, Fetzer, Sung, & Hung, 2013;Williams et al, 2012). In these studies, problem-solving was part of the patient education to assist patients to select appropriate food, remember to take medication, or list ways of overcoming their problems to change their behaviour to manage their disease.…”

“…The fifth systematic review (Lin et al, 2017) included two pre-dialysis studies, of which one was published in Chinese, leaving only Blakeman et al (2014) suitable for inclusion in this literature review.…”

“…From these five systematic reviews involving 1,011 patients with CKD who were not on dialysis, eight RCTs examined CKD self-management interventions (Blakeman et al, 2014;Byrne et al, 2011;Campbell et al, 2008;Chen et al, 2011;Flesher et al, 2011;Paes-Barreto et al, 2013;Teng et al, 2013;Williams et al, 2012). Since the systematic reviews have been published there has been one further RCT (Joboshi & Oka, 2016), included in …”

“…Of the nine studies, two were conducted in Australia (Campbell et al, 2008;Williams et al, 2012), two in the U.K. (Blakeman et al, 2014;Byrne et al, 2011), two in Taiwan (Chen et al, 2011;Teng et al, 2013), and one each in Canada (Flesher et al, 2011), Brazil (Paes-Barreto et al, 2013 and Japan (Joboshi & Oka, 2016). Five of the studies used a theory to inform the development of the intervention.…”