Patterns of Healthcare Encounters Experienced by Patients With Chronic Kidney Disease

Welch, Janet L.; Meek, Julie A.; Ellis, Rebecca J. Bartlett; Ambuehl, Roberta; Decker, Brian S.

doi:10.1111/jorc.12200

Cited by 4 publications

(8 citation statements)

References 32 publications

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“…Another explanation is the complexity of the study patient cohort, with all critical events recorded during this study deemed to be unavoidable. We found that respiratory distress was the most common trigger to both EDP and IPA compared to findings in other studies of patients with CKD [ 8 ] or cancer [ 54 ] where pain was more likely to trigger an EDP. Patients with advanced CKD will benefit from palliative care input to initiate end-of-life discussions and to help determine future goals of care [ 55 ] such as their preferred place of care and withdrawal from dialysis.…”

Section: Discussioncontrasting

confidence: 47%

“…Previous studies identifying patterns in health service utilisation in those with CKD are limited by their retrospective design, reliance on various forms of administrative health and insurance data [ 8 , 11 , 33 ] and/or incomplete capture of individual patient-level data. These limitations are shared by previous Australian studies of service use near the end of life [ 34 – 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several other studies report people with advanced CKD are high users of health services [ 8 , 11 , 39 ]. The later stages of CKD is characterised by multiple comorbidities, [ 40 ], high symptom burden [ 23 , 41 – 44 ] and a highly variable premature life expectancy [ 45 – 48 ].…”

Section: Discussionmentioning

confidence: 99%

“…CKD is characterised by a sustained reduction in kidney function (estimated glomerular filtration rate [eGFR] ≤60 ml/min/1.73m 2 [ 3 ] with the leading causes being diabetes and hypertension [ 4 ]. In Australia, where the prevalence of CKD is around 10% [ 5 ], the greatest growth in incidence is in those aged over 65 years [ 6 ] who tend to have more comorbid conditions, and greater frailty [ 7 ], collectively translating to a greater need for health care services [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…CKD is often related to, or is an underlying condition in, many other admitted disease groups, such as cardiovascular and diabetes [ 14 ]. It is a signal for heavy use of health services, reflecting the medical complexity of this group of patients [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5

et al. 2018

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BackgroundChronic kidney disease (CKD) is a growing global problem affecting around 10% of many countries’ populations. Providing appropriate palliative care services (PCS) to those with advanced kidney disease is becoming paramount. Palliative/supportive care alongside usual CKD clinical treatment is gaining acceptance in nephrology services although the collaboration with and use of PCS is not consistent.MethodsThe goal of this study was to track and quantify the health service utilisation of people with CKD stages 3-5 over the last 12 months of life. Patients were recruited from a kidney health service (Queensland, Australia) for this prospective, longitudinal study. Data were collected for 12 months (or until death, whichever was sooner) during 2015-17 from administrative health sources. Emergency department presentations (EDP) and inpatient admissions (IPA) (collectively referred to as critical events) were reviewed by two Nephrologists to gauge if the events were avoidable.ResultsParticipants (n = 19) with a median age of 78 years (range 42-90), were mostly male (63%), 79% had CKD stage 5, and were heavy users of health services during the study period. Fifteen patients (79%) collectively recorded 44 EDP; 61% occurred after-hours, 91% were triaged as imminently and potentially life-threatening and 73% were admitted. Seventy-four IPA were collectively recorded across 16 patients (84%); 14% occurred on weekends or public holidays. Median length of stay was 3 days (range 1-29). The median number of EDP and IPA per patient was 1 and 2 (range 0-12 and 0-20) respectively. The most common trigger to both EDP (30%) and IPA (15%) was respiratory distress. By study end 37% of patients died, 63% were known to PCS and 11% rejected a referral to a PCS. All critical events were deemed unavoidable.ConclusionsFew patients avoided using acute health care services in a 12 month period, highlighting the high service needs of this cohort throughout the long, slow decline of CKD. Proactive end-of-life care earlier in the disease trajectory through integrating renal and palliative care teams may avoid acute presentations to hospital through better symptom management and planned care pathways.

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Section: Discussioncontrasting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5

et al. 2018

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Digital health interventions in chronic kidney disease: levelling the playing field?

Graham-Brown

Smith

Greenwood

2022

Clinical Kidney Journal

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Digital health interventions (DHIs) have long been thought of as a convenient way to deliver aspects of healthcare and broaden access to services. For patients with chronic kidney disease, DHIs designed to improve health literacy, self-efficacy and health-related behaviours like physical activity, diet and adherence have been developed and are being tested, but their translation into clinical practice will challenging. Whilst DHIs potentially have broad reach, it is increasingly clear that patients from lower socioeconomic and educational backgrounds, minority ethnic groups, elderly patients and those who face digital poverty are the least likely to access and benefit from DHIs, when they are precisely the patients who stand to gain the most. This article discusses the potential for DHIs to level the playing field for patients with chronic kidney disease as well as the steps researchers, clinicians and developers should consider to ensure DHIs are developed, in collaboration with patients, to be inclusive and effective as well as strategies that should be considered during development to support translation into practice.

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A Novel Interprofessional Palliative Care and Geriatrics Curriculum for Nephrology Teams

Fulton

Richman

Azar

et al. 2020

Am J Hosp Palliat Care

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Background: The population of older adults with chronic kidney disease (CKD) is increasing and nephrologists need education on the principles of geriatrics and palliative care to effectively care for this population. Objectives: Our objective was to develop and deliver a curriculum to interprofessional clinicians caring for older adults with CKD. The aim of this curriculum would be to improve knowledge of the principles of geriatrics and palliative care. Design: We have previously developed a curriculum on geriatrics and palliative care targeted toward primary care teams. In this project, we used an interdisciplinary steering committee to modify the curriculum for nephrology teams. Setting: This curriculum was delivered in a live grand rounds setting and was recorded and made available via online platform for virtual learning. Participants: The 6-session curriculum was delivered to 611 live and online learners between January 2018 and April 2019, with more than half of the participants (n = 317) completing more than 1 session. Participants came from a variety of disciplines including medicine, nursing, pharmacy, and social work. Results: Participants had a high rate of agreement with the statement that the curriculum met learning objectives, with live participants having stronger agreement. Participants reported that the activity would change their practice behavior by calling palliative care earlier, as well as improving their communication skills. Conclusion: Interprofessional collaboration can result in improved learning around the management of patients with CKD or end-stage kidney disease.

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Patterns of Healthcare Encounters Experienced by Patients With Chronic Kidney Disease

Cited by 4 publications

References 32 publications

Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5

Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5

Digital health interventions in chronic kidney disease: levelling the playing field?

A Novel Interprofessional Palliative Care and Geriatrics Curriculum for Nephrology Teams

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