Patient engagement and patient-centred care in the management of advanced chronic kidney disease and chronic kidney failure.
Patient engagement and patient-centred care in the management of advanced chronic kidney disease and chronic kidney failure.
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DOI：
10.1186/s40697-014-0024-7
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发表时间：
2014
影响因子：
1.7
通讯作者：
Stockie S
中科院分区：
文献类型：
--
作者：
Bear RA;Stockie S
本文旨在回顾以患者为中心的护理（PCC）和患者参与（PE）在晚期慢性肾脏病（CKD）和终末期肾脏病（ESRD）患者管理中的现状，以确定实现PCC和PE存在的一些障碍，并描述如何克服这些障碍。该综述基于其中一位作者（RB）作为肾病学家和医疗保健顾问的专业经验、其中一位作者（SS）的MBA论文以及对相关基于互联网的信息和已发表文献的综述。有证据表明，目前，晚期CKD和ESRD患者的护理并不完全以患者为中心或完全支持PE。存在一些障碍，包括：与其他优先事项冲突;缺乏培训和害怕改变;病人和提供者之间的权力不平等;医生文化和行为;医生报酬的收费服务模式;电子健康记录实施缓慢;以及害怕问责。这些障碍可以通过坚定的领导和制定基于信息的执行计划来克服。加拿大已建立的肾脏机构似乎有兴趣通过合作开发ESRD计划使用的推荐教育资源和首选实施实践工具包来促进这项工作。本综述的一个局限性是缺乏关于这一主题的大量现有文献。接受以患者为中心并促进PE的护理使患有严重慢性疾病（如晚期CKD和ESRD）的患者受益。ESRD计划需要开展大量工作，以确保提供此类护理。加拿大肾脏机构可以发挥重要作用，确保终末期肾病项目能够获得基本的教育材料和经过验证的实施方法，并庆祝实施成功。在这一领域，需要有利的政策，以及侧重于衡量结果的临床研究。
The purpose of this article is to review the current status of patient-centred care (PCC) and patient engagement (PE) in the management of patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD), to identify some of the barriers that exist to the achievement of PCC and PE, and to describe how these barriers can be overcome. The review is based on the professional experience of one of the authors (RB) as a Nephrologist and health care consultant, on the MBA thesis of one of the authors (SS) and on a review of pertinent internet-based information and published literature. Evidence exists that, currently, the care of patients with advanced CKD and ESRD is not fully patient-centred or fully supportive of PE. A number of barriers exist, including: conflict with other priorities; lack of training and fear of change; the unequal balance of power between patients and providers; physician culture and behaviour; the fee-for-service model of physician compensation; slow implementation of electronic health records; and, fear of accountability. These barriers can be overcome by committed leadership and the development of an information-based implementation plan. Established Renal Agencies in Canada appear interested in facilitating this work by collaborating in the development of a toolkit of recommended educational resources and preferred implementation practices for use by ESRD Programs. A limitation of this review is the absence of a substantial pre-existing literature on this topic. Receiving care that is patient-centred and that promotes PE benefits patients with serious chronic diseases such as advanced CKD and ESRD. Considerable work is required by ESRD Programs to ensure that such care is provided. Canadian Renal Agencies can play an important role by ensuring that ESRD Programs have access to essential educational material and proven implementation approaches and that implementation successes are celebrated. In this area, enabling policies are required, as are clinical research studies focusing on the measurement of outcomes.