Nursing Intervention Aimed at Improving Self-Managementfor Persons with Chronic Kidney Disease in North Carolina Medicaid: A Pilot Project.

This pilot project aimed to improve knowledge and self-management among Medicaid beneficiaries with Stage 3b and 4 chronic kidney disease who were identified using a population-based approach. Participants received up to six in-person educational sessions delivered by a nurse practitioner. Increases in knowledge and self-reported behavior changes were generally observed among participants.

Evaluation of the Scored Questionnaire to Identify Individuals with Chronic Kidney Disease in a Community-based Screening Program in Rural North Carolina.

BACKGROUND: Just over 10 percent of US adults over twenty years of age have chronic kidney disease (CKD). Early detection is essential to delay or halt CKD's progression, but screening and early detection of CKD in high risk populations is inconsistent, especially in rural and underserved communities. OBJECTIVE: The objective of this study was to evaluate the effectiveness of the Screening for Occult Renal Disease questionnaire as a simple, self-report tool to identify individuals with increased likelihood of prevalent CKD in a rural North Carolina setting. METHODS: Over an eight month period, in the context of the Kidney Education Outreach Program (KEOP), sixteen CKD screenings were conducted in two underserved, rural NC communities. For this study, the SCORED questionnaire was administered prior to the execution of the regular KEOP screening protocol. RESULTS: For 172 participants for whom both blood and urine specimens were collected, there were fifteen (8.7%) who demonstrated less than normal kidney function. The SCORED sensitivity and specificity were 100% and 42%, respectively. The positive predictive value was 14% and the negative predictive value was 100%. The positive likelihood ratio for low eGFR was 1.7 and conversely, the negative likelihood ratio for low eGFR was zero. CONCLUSION: In this study, the SCORED performed comparably to previous settings in established datasets and cohort studies, with high sensitivity and negative predictive values that allow for ruling out the presence of disease. SCORED appears to provides a practical alternative to the administration of regular CKD screening protocols that can be difficult to organize and administer in rural settings. The need for further evaluation of SCORED in underserved, high-risk communities is recommended.

A clinical tool to measure the components of health-care transition from pediatric care to adult care: the UNC TR(x)ANSITION scale.

OBJECTIVE: To describe the development of the University of North Carolina (UNC) TR(x)ANSITION Scale that measures the health-care transition and self-management skills by youth with chronic health conditions. METHODS: Item and scale development of the UNC TR(x)ANSITION Scale was informed by two theoretical models, available literature, and expert opinion interviews and feedback from youth with chronic conditions, their parents, and interdisciplinary collaboration. Through an iterative process, three versions of the scale were piloted on a total of 185 adolescents and emerging adults with different chronic illnesses. This clinically administered scale relies on a semi-structured interview format of the patient and does not rely solely on patient report, but is verified with information from the medical record to validate responses. RESULTS: Following the item development and the three iterations of the scale, version 3 was examined in a more intensive fashion. The current version of the UNC TR(x)ANSITION Scale comprises 33 items scattered across the following 10 domains: Type of illness, Rx=medications, Adherence, Nutrition, Self-management, Informed-reproduction, Trade/school, Insurance, Ongoing support, and New health providers. It requires approximately 7-8 min to administer. With a sample of 128 adolescents and young adults, ranging in age from 12 to 20, inter-rater reliability was strong (r = 0.71) and item-total correlation scores were moderate to high. Content and construct validity were satisfactory, and the overall score was sensitive to advancing age. The univariate linear regression yielded a beta coefficient of 1.08 (p < 0.0001), indicating that the total score increased with advancing age. Specifically, there was about a one point increase in the total score for each year of age. CONCLUSION: The UNC TR(x)ANSITION Scale is a disease-neutral tool that can be used in the clinical setting. Initial findings suggest that it is a reliable and valid tool that has the potential to measure health-care transition skill mastery and knowledge in a multidimensional fashion.

Community perspectives on kidney disease and health promotion from at-risk populations in rural North Carolina, USA.

INTRODUCTION: Chronic kidney disease (CKD) and its progression to end-stage kidney disease (ESKD), requiring lifelong dialysis or kidney transplant, has become a public health epidemic and a financial burden on healthcare systems. The lack of available and appropriately targeted kidney disease education may account for the low awareness of kidney disease, especially among high risk populations. This low awareness can lead to late detection of CKD and an increased likelihood of progression to ESKD. This study utilized focus groups to assess community perceptions of kidney disease, barriers to health care, and educational interventions. METHODS: Seventeen focus groups were conducted with 201 participants in 5 rural North Carolina counties to assess perceptions of kidney disease, barriers to health care and strategies for raising awareness. Qualitative data analysis was performed based on a grounded theory approach. RESULTS: Of the 201 participants, 74% were African-American, 96% knew someone with diabetes or hypertension, and 76% of groups contained at least one participant with a family member or friend diagnosed with ESKD. Participants were aware that kidneys acted as filters and mechanisms to cleanse the blood, and stated that alcohol, soda, obesity, diet, and urination problems were risk factors for developing CKD. Participants consistently mentioned that symptoms and risk factors for CKD were key pieces of knowledge. Affordability of health services, medicine, and insurance was seen as the biggest barrier to health care in the communities studied; knowing how to better communicate with physicians was also important. Television and word-of-mouth were mentioned most often as the best tools for outreach and education. Wal-Mart (a chain of large, discount department and grocery stores) and community churches were most commonly mentioned as potential places for screenings. CONCLUSION: Results indicate that there is some basic community knowledge about kidney disease but the risk of developing kidney disease is often directly attributed to lifestyle behaviors rather than diabetes, hypertension, or cardiovascular disease. Future educational interventions need to be focused on the risk factors for kidney disease, and must address financial and geographic barriers to health care and poor communication between consumers and healthcare professionals.

The Kidney Education Outreach Program's community-based screenings: participants' demographics and screening results.

OBJECTIVE: To outline the Kidney Education Outreach Program (KEOP) screening protocol, to describe the context in which these chronic kidney disease (CKD) screenings were administered, and to report the characteristics and screening results for participants from October 2005 to September 2008. METHODS: A cohort of 1742 people participated in targeted, free, community-based CKD screenings. Screenings included a self-report questionnaire regarding sociodemographic information, lifestyle behaviors, and personal and family health history. This survey was followed by urine dipstick testing for proteinuria and microalbuminuria. RESULTS: Medical histories were provided by 1694 individuals: 1522 through the complete questionnaire and 172 through an abbreviated questionnaire that differed principally in lack of information on family history of disease. Urine samples were collected from 1706 participants. The mean age of screening participants was 54 years old; 70% were female, 50% were African American, and 13% were Latino. More than 40% of subjects were obese. Roughly one-quarter (23%) had been diagnosed with diabetes mellitus and about half (47%) had been diagnosed with hypertension. Twenty-four percent reported a family history of kidney disease. While 60% of the participants tested positive for microalbuminuria, less than 4% of these persons had ever been told they had kidney disease. LIMITATIONS: Lack of confirmatory testing with a serum creatinine (and estimated glomerular filtration rate) or, alternatively, with a 24-hour urine collection for creatinine clearance and protein excretion; no standardized follow-up for screened participants. DISCUSSION: The KEOP targeted screenings disclosed a high prevalence of known risk factors for CKD--diabetes mellitus, hypertension, obesity, advanced age, and family history of kidney disease. However, despite these factors, less than 4% of screened participants were aware of a diagnosis of CKD.

Can participation in a health affairs interdisciplinary case conference improve medical students' knowledge and attitudes?

PURPOSE: To explore whether participation in a three-hour health affairs interdisciplinary case conference (HAICC) changed medical students' knowledge and attitudes about the role of interdisciplinary teams in health care. METHOD: Faculty from ten University of North Carolina at Chapel Hill health professions' schools helped to design the HAICC. Conference goals included improving students' knowledge and attitudes about the skills of various health professions and the benefits of interdisciplinary care. From 2001-04, 2,005 health professions students, including 615 second-year medical students, participated in the HAICC. Working in teams, students, using the World Health Organization's International Classification of Function and Disability, interviewed a standardized patient and, then, developed a patient-centered management plan. A self-report instrument to assess medical students' knowledge about each of the ten health professions and to assess students' attitudes about working with other health professionals was administered before and after the conference. Repeated measures were used to assess whether medical students' knowledge and attitudes about interdisciplinary teams changed as a result of participating in HAICC. RESULTS: A total of 605 medical students (98.5%) completed both instruments. Following participation in the HAICC, there were significant increases in students' knowledge about the training and skills of all ten professions, the advantages of working in an interdisciplinary team, and the importance of care provided by these professions. In general, there were significant improvements in students' attitudes toward the value of interdisciplinary team work and leadership by all health professionals. CONCLUSIONS: Participation in a three-hour HAICC resulted in medical students' increased knowledge about and attitudes toward the role of interdisciplinary teams in health care.