Transcript Barriers to Effective Phosphate Control in a Dialysis

Barriers to Effective Phosphate
Control in a Dialysis
Population – The Patients
Perspective
Amanda Waller – Practice/Professional
Development Sister
Renal Services
Aims of Presentation
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Discuss renal units Research and Practice
Development Group
To highlight Trusts research award
To discuss the research project being carried
out
Background
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My PDP and development plans for Renal
Services
Multidisciplinary approach
Requirement for improvement in practice
BTFHT Novice research award
The future
Background to Research
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Main research question: ‘What are the barriers
preventing some patients from achieving
adequate phosphate control’
Aims of the study: To explore patient
perspectives of what prevents them from
achieving adequate phosphate control.
To develop strategies that can be adopted by
the health care professionals to support
patients in controlling their serum phosphate.
•Patients with end stage renal failure (ESRF)
requiring renal replacement therapy either
haemodialysis or peritoneal dialysis
•Compliance with treatment regimes is a
continuing challenge for patients
•Control of serum phosphate is an important
component of this treatment
•High phosphate causes metastatic calcification
in joints and myocardium and triggers
hyperparathyroidism
•Removal of phosphate by dialysis is relatively
inefficient
•Requires the patient to restrict their phosphorous
intake (milk, dairy products, offal, cola, chocolate)
and take phosphate binding medication
•Past research has shown that dialysis patients are
prone to none compliance
•Reported rates range from 25% to 83%
•The most frequently used method to promote
compliance is the provision of information
•Studies have shown that educational
interventions can have some impact on patients
knowledge of phosphate control and their
compliance
•Growing body of research that indicates that
medical compliance involves more than educating
patients
•A previous study undertaken within renal unit
highlighted this
•Research Design : Qualitative semi-structured
interviews
•Setting : Haemodialysis (HD) and peritoneal
(PD) patients at BFTHT
•Sample: 20-25 patients receiving regular dialysis
with serum phosphate levels of > 1.8mmols/l for 3
consecutive months
•Measures: A semi structured interview schedule
has been devised to identify the patients
perceptions of issues that impact on control of
phosphate
•Inclusion Criteria: patients undergoing HD or PD
for > 6 months
•with a serum phosphate level of > 1.8 for 3
consecutive months
Who have had an intervention from a dietician for
specialist advice about control of phosphate
•Recruitment:
•Consent Process:
• Interview Process:
Questions
1) Can you tell me about how meal times are organised in
your family/home
2) If there is an event or circumstance that is a change from
your normal routine can you discuss how you would
make decisions for food choices
3) Can you tell me something about how you organise
taking your medications
4) Can you tell me something about your experience of
how hcp’s deal with issues around your phosphate levels
•Ethical Approval: Will be sought from the local
LREC
•Data Analysis: Content analysis will be used to
identify themes and categories from the
qualitative data.
•Results:
Any Questions?
References
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Ashurst IB, Dobbie H (2003) A randomised control trial of an educational intervention to improve phosphate levels in
haemodialysis patients. Journal of Renal Nutrition. 13 (4): 267 – 74
Bame SI, Peterson N & Wray N (1993) Variation in haemodialysis compliance according to demographic characteristics.
Social Science and Medicine 37 1035-1043
Deimling A, Denny M, Harrison M, Kerr B, Mayfield M (1984) Effects of an algorithm and patient information on serum
phosphorous levels. AANNT Journal 11, 34-38
Ford JC, Pope J, Hunt AE, Gerald B (2004) The effect of diet education on the laboratory values and knowledge of
haemodialysis patients with hyperphospatemia. Journal of Renal Nutrition. 14(1): 36 – 34
Katz RC, Ashmore J, Barboa E, Trueblood K, McLaughlin V, Mathews L (1998) Knowledge of disease and dietary
compliance in patients with end stage renal disease
Psychology Reports 82 (1): 331-6
Korniewicz DM & OBrien ME (1994) Evaluation of a haemodialysis patient education and support program ANNA Journal
21, 33-38
Prowant BF, Ryan P, Satalowich RJ (1989) Effectiveness of a phosphorous educational program for dialysis patients. ANNA
Journal 16, 353-357
Renal Association. Treatment of adults and children with renal failure: standards and audit measures. 3rd Edition. London.
Royal College of Physicians and the Renal Association 2002
Schlatter S, Ferrans CE (1998) Teaching program effects on high phosphorous levels in patients receiving haemodialysis
ANNA Journal 25 (1) : 31- 36
Silve C , Friedlander G (2005) Hypo- Hyperphosphataemia Oxford Textbook of Clinical Nephrology 3rd Edition Oxford
University Press, Oxford 287 – 308
Stoves J, Steel J (2006) Do improvements in patient education lead to an improvement in phosphate control? Unpublished
Bradford Hospitals NHS Trust