Looking for Adequate Return on Investment: Timing of Educating Patients about Dialysis Modalities
Looking for Adequate Return on Investment: Timing of Educating Patients about Dialysis Modalities
复制标题
寻求足够的投资回报：对患者进行透析方式教育的时机
DOI：
10.1177/089686080802800407
复制
发表时间：
2008
影响因子：
2.8
通讯作者：
R. Mehrotra
中科院分区：
文献类型：
--
作者：
R. Mehrotra
347 The use of chronic peritoneal dialysis (CPD) varies widely between different countries, between different parts of the same country, and between different units in the same region (1). In a study from the United States, a country with a low utilization of CPD, over two thirds of incident patients report that peritoneal dialysis had not been offered as a method of treatment; there was no difference in the frequency of CPD being offered in patients with or without relative medical contraindications to the therapy (2). Inadequate modality education is thus probably the most important factor that limits greater use of CPD in countries where the therapy is less expensive than in-center hemodialysis (ICHD). After all, if a patient is not aware that dialysis can be done at home, they are unlikely to choose the option. Moreover, some patients that would prefer to dialyze at home are either uncertain of their abilities or are afraid to do so (3). It follows then that there should be at least two goals for modality education: to educate patients about the possibility of performing dialysis at home and to help patients overcome their fears about the same. Several uncontrolled observational studies have demonstrated that structured modality education results in a substantial increase in CPD take-on (4,5). These findings have been further substantiated by a randomized controlled trial wherein structured patient education resulted in a substantial increase in patients’ preferences for home dialysis (6). It is widely agreed that comprehensive patient education is likely to result in higher CPD take-on. It also appears that the earlier the timing of patient education relative to the start of maintenance dialysis, the greater the probability of selection of CPD as the renal replacement modality (2). However, reports from many different parts of the world have shown that many patients that start maintenance dialysis therapy have received little or no education about CPD. The reasons for this are probably complex: some of the causes may include low enthusiasm among healthcare providers for CPD, arising from inadequate physician education and/or experience, lack of infrastructure, delayed referral of patients to nephrologists, and rapid progression of renal failure in some patients (7). What is unclear, however, is whether modality education would be effective in increasing the LOOKING FOR ADEQUATE RETURN ON INVESTMENT: TIMING OF EDUCATING PATIENTS ABOUT DIALYSIS MODALITIES
