ABSTRACT
The pilot study demonstrated facility-based, multidisciplinary team-based education adds significant value to educational practice. We continue to partner with nephrologists and other health care providers to encourage structured education programs, reach more patients to slow the progression of CKD, and manage public policy issues related to reimbursement so patients can receive necessary education. In a time when CKD education is being considered by public policymakers, it is important to demonstrate that there is value in not limiting CKD education to a specific population, and in providing that education through dialysis centers that already have the infrastructure in place to mount an effective, large-scale, standardized program.
Subject(s)
Kidney Failure, Chronic/prevention & control , Patient Education as Topic/organization & administration , Self Care/methods , Curriculum , Disease Progression , Family , Female , Health Policy , Humans , Kidney Failure, Chronic/epidemiology , Male , Middle Aged , Nephrology/organization & administration , Patient Advocacy , Patient Care Team/organization & administration , Pilot Projects , Program Development , Program Evaluation , United States/epidemiologyABSTRACT
OBJECTIVE: To study the effect of training methods on selected patient outcomes in peritoneal dialysis patients. DESIGN: Multi-center, longitudinal prospective quasi-experimental design study conducted over a 2-year period. SETTING: Thirty-two Gambro Healthcare peritoneal dialysis (PD) home training programs in the United States. SUBJECTS: New patients starting PD were trained on PD technique and diet using either an adult learning theory-based curriculum in the experimental group (PG) or non-standardized conventional training programs in the control group (CG). Excluded were patients who were non-English speaking, legally blind without sighted caregiver, nursing home residents, and those with previous exposure to PD training. METHODS: Information was collected by means of manual data collection tools and though the use of Gambro Healthcare computer system and was analyzed for statistical significance by Gambro Healthcare biostatistician. RESULTS: Compared with the CG, initial training took longer in the PG (PG = 29 hrs; CG = 22.6 hrs; p < .0001), and time required for retraining was less but not statistically significant (PG = 8.7 hrs; CG = 12.5 hrs; p = .1324). The peritonitis rate was less in the PG (28.2 per 1000 patient months) than in the CG (36.7 per 1000 patient months), but did not achieve statistical significance (p = .09783). Exit site infections (ESIs) were less in the PG than the CG (PG = 18.5; CG = 31.8; p = .00349). Dropout from PD to hemodialysis secondary to infection was less in the PG (1.6%) than in the CG (5.6%) (p = .0069). Measured on a scale with 4 being the best score, mean fluid balance scores in the PG were 3.41 compared to 3.25 in the CG (p < .0001), and mean compliance scores for the PG versus the CG were 3.62 and 3.52, respectively (p < .0001). Laboratory parameters between the two groups were significantly different only for Kt/V (PG = 2.4; CG = 2.3; p = 0.0107). CONCLUSION: Use of the adult learning theory-based training method curriculum was positively associated with improved patient outcomes in the PD population studied.
