PATTERNS OF HEALTHCARE ENCOUNTERS EXPERIENCED BY PATIENTS WITH CHRONIC KIDNEY DISEASE.

BACKGROUND: Patterns of healthcare encounters by patients in each stage of chronic kidney disease (CKD) have not been fully described. OBJECTIVE: This study describes patterns of healthcare resource use by patients with CKD. DESIGN: A retrospective descriptive design was used. PARTICIPANTS: Patients with Stages 1-5 CKD were identified in five existing de-identified healthcare insurance claims databases in the United States using codes from the International Classification of Diseases (ICD-9-CM). MEASUREMENTS: The databases contained more than 23,660,000 claims records from over 11 million subscribers who were continuously enrolled in a single 2014 health plan. All CKD patients' 2014 claims were extracted, yielding 1,987 unique people with 110,594 healthcare encounters. RESULTS: Healthcare resources are used to manage the causes of CKD and its multiple effects on health, and thus the number of healthcare encounters among people with more advanced disease was, as expected, relatively higher. There were more hospitalisations, emergency department visits and specialist encounters in this group. Surprisingly, however, even people in earlier stages of kidney disease experienced a median of 14-17 healthcare encounters during a single calendar year. CONCLUSIONS: Understanding patterns of healthcare encounters provides important information about the transition experiences of patients with CKD. Exploring ways to reduce the risks associated with transitions in care may prevent problems with home medication management, frequent emergency department visits and potentially avoidable hospitalisations.

Perceived informational needs, problems, or concerns among patients with stage 4 chronic kidney disease.

The purpose of this descriptive study was to describe the informational needs, problems, or concerns of patients with Stage 4 CKD and to describe what is desired in an educational program for them. Awareness of needs can facilitate the development of quality educational programs for this complex patient population. This study found the top four informational needs, problems, or concerns since reaching Stage 4 included knowledge of kidney disease, taking medication the physician prescribed, care of an access, and financial concerns. The top concerns about the possibility of starting dialysis included maintaining normal social relationships and treatment options. According to patients, the top four topics they would like included in an educational program are knowledge of kidney disease, care of a vascular access, treatment options, and medications. This information may extend beyond what is traditionally included in pre-dialysis educational programs.

Patterns of interdialytic weight gain during the first year of hemodialysis.

This retrospective study describes patterns of interdialytic weight gain (IWG) over the first year of hemodialysis in 27 individuals. IWG increased over the first 12 weeks and appeared to reverse after 12 weeks, increasing again after 32 weeks. Interventions may need to occur after the individual has been receiving treatment for 12 weeks; booster interventions may be indicated after 32 weeks. Variability in the two measures used (mean daily interdialytic weight gain and mean daily percent above dry weight) suggests a need for further study.

Psycho-educational strategies to promote fluid adherence in adult hemodialysis patients: a review of intervention studies.

BACKGROUND: We reviewed psycho-educational intervention studies that were designed to reduce interdialytic weight gain (IDWG) in adult hemodialysis patients. Our goals were to critique research methods, describe the effectiveness of tested interventions, and make recommendations for future research. METHODS: Medline, PsychInfo, and the Cumulative Index to Nursing and Applied Health (CINAHL) databases were searched to identify empirical work. Each study was evaluated in terms of sample, design, theoretical framework, intervention delivery, and outcome. RESULTS: Nine studies were reviewed. Self-monitoring appears to be a promising strategy to be considered to reduce IDWG. Theory was not usually used to guide interventions, designs generally had control groups, interventions were delivered individually, more than one intervention was delivered at a time, the duration of the intervention varied greatly, there was no long-term follow-up, IDWG was the only outcome, and IDWG was operationalized in different ways. CONCLUSIONS: Theoretical models and methodological rigor are needed to guide future research. Specific recommendations on design, measurement, and conceptual issues are offered to enhance the effectiveness of future research.

A cost-effectiveness worksheet for patient-education programs.

This article describes the development, implementation, and evaluation of a worksheet used by nursing faculty in a graduate clinical nurse specialist course to assist students in learning to estimate the cost-effectiveness of patient-education programs.1 The worksheet was found to be a satisfactory method of facilitating student learning and could also be used in the service arena to evaluate the cost aspects of patient-education programs.