Shared Hemodialysis Care

Wilkie, Martin; Barnes, Tania

doi:10.2215/cjn.02050219

Cited by 21 publications

(11 citation statements)

References 9 publications

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“…There is already evidence that patient education is associated with better patient outcomes 59 and new strategies and quality improvement programmes exist such as Shared HD, a UK programme aiming to support patients receiving in-centre HD to be more independent and confident in participating in aspects of their own care. 60 Potential barriers are cost and resources, but increasingly, accredited online learning facilities are available. However, it is acknowledged, staff in this study indicated a preference for face-to-face training.…”

Section: Discussionmentioning

confidence: 99%

Using patient-reported outcome measures during the management of patients with end-stage kidney disease requiring treatment with haemodialysis (PROM-HD): a qualitative study

et al. 2021

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ObjectivesPatients undergoing haemodialysis report elevated symptoms and reduced health-related quality of life, and often prioritise improvements in psychosocial well-being over long-term survival. Systematic collection and use of patient-reported outcomes (PROs) may help support tailored healthcare and improve outcomes. This study investigates the methodological basis for routine PRO assessment, particularly using electronic formats (ePROs), to maximise the potential of PRO use, through exploration of the experiences, views and perceptions of patients and healthcare professionals (HCPs) on implementation and use of PROs in haemodialysis settings.Study designQualitative study.Setting and participantsSemistructured interviews with 22 patients undergoing haemodialysis, and 17 HCPs in the UK.Analytical approachTranscripts were analysed deductively using the Consolidated Framework for Implementation Research (CFIR) and inductively using thematic analysis.ResultsFor effective implementation, the potential value of PROs needs to be demonstrated empirically to stakeholders. Any intervention must remain flexible enough for individual and aggregate use, measuring outcomes that matter to patients and clinicians, while maintaining operational simplicity. Any implementation must sit within a wider framework of education and support for both patients and clinicians who demonstrate varying previous experience of using PROs and often confuse related concepts. Implementation plans must recognise the multidimensionality of end-stage kidney disease and treatment by haemodialysis, while acknowledging the associated challenges of delivering care in a highly specialised environment. To support implementation, careful consideration needs to be given to barriers and facilitators including effective leadership, the role of champions, effective launch and ongoing evaluation.ConclusionsUsing the CFIR to explore the experiences, views and perceptions of key stakeholders, this study identified key factors at organisational and individual levels which could assist effective implementation of ePROs in haemodialysis settings. Further research will be required to evaluate subsequent ePRO interventions to demonstrate the impact and benefit to the dialysis community.

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Section: Discussionmentioning

confidence: 99%

Using patient-reported outcome measures during the management of patients with end-stage kidney disease requiring treatment with haemodialysis (PROM-HD): a qualitative study

et al. 2021

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“…Patients with low activation are highrisk patients in need for more surveillance and need an integrated approach to improve their activation. To influence a meaningful and sustainable change in dialysis care that improves patient activation, we will need an integrated approach that involves people on dialysis, their healthcare team, dialysis providers, and policy makers (48,49). Interventions that can be considered include health coaching, peer mentoring, and involving patients more in their dialysis care (50)(51)(52)(53).…”

Section: Discussionmentioning

confidence: 99%

Patient Activation Among Prevalent Hemodialysis Patients: An Observational Cross-Sectional Study

Hussein

Bennett

Sun

et al. 2022

Journal of Patient Experience

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Patient activation is the product of knowledge, skills, and confidence that enables a person to manage their own healthcare. It is associated with healthy behaviors and improved patient outcomes. We surveyed prevalent hemodialysis (HD) patients at 10 centers using the Patient Activation Measure 13-item instrument (PAM-13). Activation was reported as scores (0-100) and corresponding levels (1-4). Of 1149 eligible patients, surveys were completed by 925 patients (92% response rate). Mean age was 62 ± 14 years, 40% were female, median vintage was 41 (IQR 19-77) months, and 66% had diabetes. Mean PAM score was 56 ± 13, with 14%, 50%, 25%, and 10% in levels 1 to 4, respectively. In adjusted analysis, older age and having diabetes were associated with lower activation, whereas higher educational levels and female gender were associated with higher scores. Significant variation in activation was observed among participants from different centers even after adjustment for other variables. In conclusion, low activation is common among prevalent HD patients.

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“…31 These approaches can be enhanced by leveraging technology (telehealth), increasing patient's access to their own health records and measures such as patient reported outcomes. 27 These interventions have resulted in increased engagement 32 and confidence, reduced anxiety, 31 improved clinical outcomes, 30,33 improved patient-reported quality of life, 34 satisfaction with care, 35 increased satisfaction with modality decision making, 36 and potentially increased number of patients moving to home dialysis. 31 The ultimate goal of our early dialysis care would be to increase a person's activation by increasing their knowledge, skills, and confidence so that they are able to manage their own health and health care.…”

Section: Discussionmentioning

confidence: 99%

“…27 These interventions have resulted in increased engagement 32 and confidence, reduced anxiety, 31 improved clinical outcomes, 30,33 improved patient-reported quality of life, 34 satisfaction with care, 35 increased satisfaction with modality decision making, 36 and potentially increased number of patients moving to home dialysis. 31 The ultimate goal of our early dialysis care would be to increase a person's activation by increasing their knowledge, skills, and confidence so that they are able to manage their own health and health care. The expected improvements in healthy behaviors and ownership of one's health care is the essence of person-centered care, and will support the transition to value-based care and the achievement of the quadruple aim: better patient outcomes; improved clinical experience; improved patient experience; and lower costs.…”

Section: Discussionmentioning

confidence: 99%

Changes in patient activation in people starting dialysis: A prospective longitudinal, observational study

Hussein

Bennett

Carrasco

et al. 2022

Hemodialysis International

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Introduction: Increased patient activation is associated with improved health outcomes; however, little is known about patient activation in people with end-stage kidney disease at the start of their dialysis journey. This study aimed to measure activation status changes over the first 4 months of dialysis.Methods: Prospective, longitudinal, and observational study. Incident patients initiating dialysis at 25 in-center hemodialysis and 17 home dialysis programs across three US states managed by the same dialysis provider completed the 13-item Patient Activation Measure (PAM-13) survey at baseline (month 1 after commencement of dialysis) and follow-up (month 4). The survey yields a score (0-100) that corresponds to four levels (1-4), with higher scores or levels indicating higher activation.Findings: One hundred eighty-two participants (139 center, 43 home) completed both baseline and follow-up surveys. Mean age was 60 AE 15 years, 40% female. Mean PAM-13 scores were 65.1 AE 16.8 and 64.8 AE 17.8 at baseline and follow-up, respectively; mean intraindividual change: À0.3 AE 17.3. The proportions of patients at levels 1-4 at baseline were 11%, 23%, 35%, and 31% respectively. At follow-up, 50%, 64%, 52%, and 37% of participants at levels 1-4, respectively, changed to a different PAM level (Spearman correlation = 0.47; p < 0.001). Home dialysis was associated with higher PAM scores when compared to in-center hemodialysis in multivariable analyses, adjusted for sociodemographic variables, comorbidities, and predialysis nephrology care (β = 5.74, 95% confidence intervals [CI]: 0.11-11.37 and 9.02, 95% CI: 3.03-15.02, at baseline and follow-up, respectively).Discussion: Although aggregated group scores and levels remained stable, intra-individual patient activation changed significantly during the first 4 months of dialysis. This novel finding is foundational to future projects aiming to design interventions to improve patient activation.

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Shared Hemodialysis Care

Cited by 21 publications

References 9 publications

Using patient-reported outcome measures during the management of patients with end-stage kidney disease requiring treatment with haemodialysis (PROM-HD): a qualitative study

Using patient-reported outcome measures during the management of patients with end-stage kidney disease requiring treatment with haemodialysis (PROM-HD): a qualitative study

Patient Activation Among Prevalent Hemodialysis Patients: An Observational Cross-Sectional Study

Changes in patient activation in people starting dialysis: A prospective longitudinal, observational study

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