Perceived barriers to guidelines in peritoneal dialysis

Allen, Nathan; Schwartz, Daniel K.; Sood, Amy R.; Mendelssohn, David C.; Verrelli, Mauro; Tanna, Gemini; Schiff, Jeff; Komenda, Paul; Rigatto, Claudio; Sood, Manish M.

doi:10.1093/ndt/gfq623

Cited by 9 publications

(9 citation statements)

References 27 publications

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“…The literature review found limited previous research exploring the control variables and EBP use for providers. One study showed that shorter length of clinical practice for physicians was significantly associated with an increased use in evidence‐based medicine guidelines (Allen et al, ). The results of this study using age as a proxy for clinical experience did not support this previous finding.…”

Section: Discussion and Research Implicationsmentioning

confidence: 99%

An Exploration of Context and the Use of Evidence‐Based Nonpharmacological Practices in Emergency Departments

Wente

Kleiber

2013

Worldviews Ev Based Nurs

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Regression analyses found that overall context significantly predicted the use of EBPPM for RNs and providers although no one element-individual, unit, or hospital-was identified as more important. The effect of context on EBNPP did not differ by profession in this sample. Future research should focus on the overall influence of context on EBP and consider other factors that may play a role in the uptake of EBP.

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Section: Discussion and Research Implicationsmentioning

confidence: 99%

An Exploration of Context and the Use of Evidence‐Based Nonpharmacological Practices in Emergency Departments

Wente

Kleiber

2013

Worldviews Ev Based Nurs

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“…Our survey was distributed to Nephrology Now subscribers with survey methodology and population surveyed described elsewhere (please see additional file 1 for the original survey instrument) [ 10 , 11 ]. In brief, Nephrology Now is a non-profit, online, free email alert service that selects nephrology journal articles and incorporates them into a monthly mailing list http://www.nephrologynow.com .…”

Section: Methodsmentioning

confidence: 99%

International practice patterns and factors associated with non-conventional hemodialysis utilization

et al. 2011

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BackgroundThe purpose of our study was to determine characteristics that influence the utilization of non-conventional hemodialysis (NCHD) therapies and its subtypes (nocturnal (NHD), short daily (SDHD), long conventional (LCHD) and conventional hemodialysis (CHD) as well as provider attitudes regarding the evidence for NCHD use.MethodsAn international cohort of subscribers of a nephrology education website http://www.nephrologynow.com was invited to participate in an online survey. Non-conventional hemodialysis was defined as any forms of hemodialysis delivered > 3 treatments per week and/or > 4 hours per session. NHD and SDHD included both home and in-centre. Respondents were categorized as CHD if their centre only offered conventional thrice weekly hemodialysis. Variables associated with NCHD and its subtypes were determined using multivariate logistic regression analysis. The survey assessed multiple domains regarding NCHD including reasons for initiating and discontinuing, for not offering and attitudes regarding evidence.Results544 surveys were completed leading to a 15.6% response rate. The final cohort was limited to 311 physicians. Dialysis modalities utilized among the respondents were as follows: NCHD194 (62.4%), NHD 83 (26.7%), SDHD 107 (34.4%), LCHD 81 (26%) and CHD 117 (37.6%). The geographic regions of participants were as follows: 11.9% Canada, 26.7% USA, 21.5% Europe, 6.1% Australia/New Zealand, 10% Africa/Middle East, 10.9% Asia and 12.9% South America. Variables associated with NCHD utilization included NCHD training (OR 2.47 CI 1.25-4.16), government physician reimbursement (OR 2.66, CI 1.11-6.40), practicing at an academic centre (OR 2.28 CI 1.25-4.16), higher national health care expenditure and number of ESRD patients per centre. Hemodialysis providers with patients on NCHD were significantly more likely to agree with the statements that NCHD improves quality of life, improves nutritional status, reduces EPO requirements and is cost effective. The most common reasons to initiate NCHD were driven by patient preference and the desire to improve volume control and global health outcomes.ConclusionPhysician attitudes toward the evidence for NCHD differ significantly between NCHD providers and conventional HD providers. Interventions and health policy targeting these areas along with increased physician education and training in NCHD modalities may be effective in increasing its utilization.

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“…However, in particular, in private settings, or under strong cost constraints, treatment choices may be affected by the reimbursement system, which is graded for levels of care in many countries. Indeed, reimbursement is often higher for in-hospital and lower for home-based treatments, a policy that tends to disincentivize home dialysis in all its forms [ 44 , 45 , 46 , 47 , 48 ].…”

Section: Introductionmentioning

confidence: 99%

Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline

Piccoli

Breuer

Cabiddu

et al. 2018

JCM

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Nephrology is a complex discipline, including care of kidney disease, dialysis, and transplantation. While in Europe, about 1:10 individuals is affected by chronic kidney disease (CKD), 1:1000 lives thanks to dialysis or transplantation, whose costs are as high as 2% of all the health care budget. Nephrology has important links with surgery, bioethics, cardiovascular and internal medicine, and is, not surprisingly, in a delicate balance between specialization and comprehensiveness, development and consolidation, cost constraints, and competition with internal medicine and other specialties. This paper proposes an interpretation of the different systems of nephrology care summarising the present choices into three not mutually exclusive main models (“scientific”, “pragmatic”, “holistic”, or “comprehensive”), and hypothesizing an “ideal-utopic” prevention-based fourth one. The so-called scientific model is built around kidney transplantation and care of glomerulonephritis and immunologic diseases, which probably pose the most important challenges in our discipline, but do not mirror the most common clinical problems. Conversely, the pragmatic one is built around dialysis (the most expensive and frequent mode of renal replacement therapy) and pre-dialysis treatment, focusing attention on the most common diseases, the holistic, or comprehensive, model comprehends both, and is integrated by several subspecialties, such as interventional nephrology, obstetric nephrology, and the ideal-utopic one is based upon prevention, and early care of common diseases. Each model has strength and weakness, which are commented to enhance discussion on the crucial issue of the philosophy of care behind its practical organization. Increased reflection and research on models of nephrology care is urgently needed if we wish to rise to the challenge of providing earlier and better care for older and more complex kidney patients with acute and chronic kidney diseases, with reduced budgets.

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Perceived barriers to guidelines in peritoneal dialysis

Abstract: International variation in guideline adherence may be influenced by a country's healthcare expenditure, physician's PDA use and experience, and size of PD practice which may impact future guideline development and implementation.

Cited by 9 publications

References 27 publications

An Exploration of Context and the Use of Evidence‐Based Nonpharmacological Practices in Emergency Departments

An Exploration of Context and the Use of Evidence‐Based Nonpharmacological Practices in Emergency Departments

International practice patterns and factors associated with non-conventional hemodialysis utilization

Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline

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