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Diabetic nephropathy patient empowerment

Diabetic nephropathy patient empowerment

Patienf Background Multi-morbidity due to diabetes and chronic kidney disease CKD remains patietn for Diabetic nephropathy patient empowerment health-systems, patent focus on nephroapthy diseases. The aim of Diabetic nephropathy patient empowerment report is to empower Gluten intolerance symptoms and care that is tailored to the needs neprhopathy the patient. Diabetol Metab Diabetif Sep;13 1 [ Disbetic Full text ] [ CrossRef ] [ Medline ] Molló À, Berenguera A, Rubinat E, Vlacho B, Mata M, Franch J, et al. Stacy Ogbeide, PsyD, MS, ABPP is a Board-Certified Clinical Health Psychologist and a Board-Certified Specialist in Obesity and Weight Management. Patient Priorities for Living Well: A Focus on Life Participation. We urge for greater emphasis on a strengths-based approach, as outlined in Table 1which encompasses strategies to support patient resilience, harness social connections, build patient awareness and knowledge, facilitate access to support, and establish confidence and control in self-management. Diabetic nephropathy patient empowerment

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Diabetic Nephropathy - Nephrotic Syndrome - Kidney Pathology

Diabetic nephropathy patient empowerment -

It therefore seemed appropriate to develop information material with the strong involvement of the patients. Methodology Ten people with diabetic nephropathy were invited to take part in the consultation process. Forming a quality circle group with patients who have diabetic nephropathy provided further opportunity to explore their perceived needs and to reflect on previous experiences, which were shared by members within the circle group.

It is appropriate to ask patients what concerns them, in an effort to enhance care. Consultation with patients enables a better understanding of what it means to be a patient. In this way, qualitative approaches to improving nursing care can complement existing quality assurance strategies Koch, Patients who were eligible to participate in the quality circle were people on a range of treatments for renal failure, e.

pre-dialysis, CAPD, haemodialysis and post- transplant. It was important to include representation of all these treatments in order to obtain as broad a perspective as possible in addressing information needs. The size of the group was also important, as too large a group makes it difficult for everyone to participate Hutchins, ; Stebbing, The quality circle met on four occasions in the Diabetes Centre, as planned for the purpose of the study.

Figure 5 shows a photograph of the group, which group members asked to be included as they felt it would personalise their contribution and offer support to other patients with diabetic nephropathy who use the resources.

The group acknowledged that individuals have varying needs for information, but all agreed that information should be friendly and non-medical in its approach.

They felt that the emphasis should be on practical information, ensuring that the reasons for decisions are given. Family and carers should also be included.

Many of the group members who had been faced with making decisions about their health care felt inadequately prepared. Information is known to be the best basis for making appropriate choices in health care Bradley and McGee, It addresses the key areas:.

Practical difficulties were encountered throughout the development of the booklet, but with support and planning were overcome. Group meetings, for example, were planned around the demands of treatments and multiple appointments, and included episodes of illness among some group members.

Between group meetings, the researcher liaised with colleagues from diabetes and renal teams in addition to the patient group.

Contact was maintained by telephone and writing. An audiotape of drafts of the booklet was also used for one member of the group who is blind. It was important to consider the readability of the booklet and acknowledge the help obtained from the guidelines suggested by Albert and Chadwick , who recommend that writers of information for patients should aim for a Gunning Fog Index of 12 maximum.

Involving the quality circle group ensured that the level of readability and style of materials ultimately produced accorded with their wishes and judgement.

Since accurate and consistent information is required, it seems appropriate that such resources are not produced simply for people with diabetic nephropathy but with them.

Informal evaluation of the draft material was ongoing during the development of the content, and patients and staff contributed to the final production. The consultative process helped to ensure that the finished product met the needs of the target group.

It confirmed that there was a gap in existing information for patients in this specialised area of care, and therefore a need for such a resource. Conclusion Working with the quality circle has been invaluable in helping to ensure that services were developed in a patient-centred way. Initiation of this research with patients who have diabetic nephropathy in Sheffield has enabled further service development and led to an enhanced patient service based on actual rather than perceived need.

Sadly, some of the patients are no longer with us, but they will always be remembered. Low resolution versions of Figures 1—4 can be seen in the PDF. Albert T, Chadwick S How readable are practice leaflets?

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eTable 7. Poisson Regression to Show the Association Between Incident Non-Fatal Clinical Events and Target Attainment at 12 Months in the Intention-to-Treat Population.

eTable 8. Poisson Regression to Show the Association Between Incident Non-Fatal Clinical Events and Target Attainment at 12 Months in the Per-Protocol Population. eTable 9. Baseline Clinical Characteristics of Patients Who Adhered to the Study Protocol and Returned for End-of-Study Assessment by Group Randomization in the Per-Protocol Population.

eTable Poisson Regression to Show the Association of Assignment to Team-Based Empowered Care Compared With Empowered Care and Usual Care on Attainment to Multiple Treatment Targets at 12 Months in the Per-Protocol Population.

Number of Patients With Incident Clinical Events by Group Randomization at 12 Months in the Per-Protocol Population. Number of Patients With Incident Non-Fatal Clinical Events by Target Attainment at 12 Months in the Per-Protocol Population.

Changes in the Proportion of Patients Attaining at Least 3 Treatment Targets at 12 Months in the Per-Protocol Population.

Chan JCN , Thewjitcharoen Y , Nguyen TK, et al. Effect of a Web-Based Management Guide on Risk Factors in Patients With Type 2 Diabetes and Diabetic Kidney Disease : A JADE Randomized Clinical Trial. JAMA Netw Open. Question What is the effect of using the Joint Asia Diabetes Evaluation JADE web portal, nurse reminders, and team-based care on reducing multiple risk factors in patients with diabetic kidney disease DKD?

Findings In this randomized clinical trial involving patients with DKD, those randomized to the empowered care group received a personalized report and nurse telephone calls every 3 months in addition to usual care, whereas the team-based empowered care group received additional face-to-face reviews every 3 months from a physician-nurse team.

Compared with the usual care and empowered care groups, the team-based empowered care group was more likely to attain at least 3 of the 5 treatment targets. Meaning The findings from this trial suggest that data-driven, team-based care improves patient empowerment and decreases multiple risk factors in patients with DKD.

Importance Diabetic kidney disease DKD and its comorbidities can be prevented by treating multiple targets. Technology-assisted team-based care with regular feedback and patient empowerment can improve the attainment of multiple targets and clinical outcomes in patients with type 2 diabetes, but the effects of this intervention on patients with DKD are unclear.

Objective To evaluate the effect of the Joint Asia Diabetes Evaluation JADE web portal, nurse reminders, and team-based care on multiple risk factors in patients with DKD. Design, Setting, and Participants This month multinational, open-label randomized clinical trial was conducted between June 27, , and February 19, , at 13 hospital-based diabetes centers in 8 countries or regions in Asia.

All patients who participated had DKD. The intention-to-treat data analysis was performed from April 7 to June 30, Interventions Patients were randomized in a ratio at each site to usual care, empowered care, or team-based empowered care. All patients underwent a JADE web portal—guided structured assessment at baseline and month Patients in the usual care and empowered care groups received a medical follow-up.

Patients in the empowered care group also received a personalized JADE report and nurse telephone calls every 3 months. Patients in the team-based empowered care group received additional face-to-face reviews every 3 months from a physician-nurse team. Results A total of patients mean [SD] age, At baseline, On intention-to-treat analysis, the team-based empowered care group had the highest proportion of patients who had further increase in attainment of multiple treatment targets within-group differences: usual care group, 3.

The team-based empowered care group was more likely to attain multiple treatment targets than the usual care group risk ratio [RR], 1. Compared with the group that did not attain multiple treatment targets, the group that attained multiple treatment targets reported a lower incidence of cardiovascular, kidney, and cancer events 8.

Analysis of the per-protocol population yielded similar results. Conclusions and Relevance This trial found that technology-assisted team-based care for 12 months improved the attainment of multiple treatment targets as well as empowerment in patients with DKD.

Trial Registration ClinicalTrials. gov Identifier: NCT Diabetes is the leading cause of chronic kidney disease and end-stage kidney disease worldwide.

In clinical practice, target attainment rates are low, often because of delayed intervention and suboptimal self-management. The importance of early detection, risk stratification, and timely management of DKD calls for more comprehensive implementation strategies.

We hypothesized that the JADE web portal—assisted team-based care along with regular feedback and patient empowerment is a viable strategy for improving treatment target attainment and outcomes in this patient population see trial protocol in Supplement 1.

Each site was either given a grant, which was equivalent to an month nurse salary at that center, to recruit patients or was paid pro rata. The RCT complied with the Declaration of Helsinki 17 and received approval from the local institutional review boards of the participating centers.

All participating patients signed a written informed consent form before study enrollment. The present study followed the Consolidated Standards of Reporting Trials CONSORT reporting guideline. Between June 27, , and March 21, , we screened patients. At each site, patients self-reported their own race and ethnicity Chinese, Filipino, Indian, Korean, Malay, Thai, and Vietnamese and were verified by attending clinicians.

All eligible patients had type 2 diabetes, which was defined as nonketotic presentation or no insulin requirement within 1 year of diagnosis. Eligible patients at each study site were randomized in a ratio to usual care, empowered care, or team-based empowered care Figure 1. Computer-generated assignment codes were put in sealed, opaque, and consecutively numbered envelopes and then opened by non—study personnel at the site.

Patients, investigators, and nurses were not blinded according to the design of the study. The JADE web portal was developed and has been managed by the Asia Diabetes Foundation since , and its functions have been described elsewhere. The portal incorporates validated risk equations for risk stratification and issues a personalized report with automated decision support for patients and physicians.

The aim of this report is to empower self-management and care that is tailored to the needs of the patient. Systematic data collection is the basis of a register, which can be created to inform practice and policies. During a 1. All sites were given an operating manual with instructions on care organization, care protocols, evaluation procedures, use of the JADE web portal, and interpretation and explanation of the JADE personalized reports.

In general, messages in the patient report focus on self-management and treatment adherence, whereas messages in the physician report focus on early intervention, use of organ-protective drugs, and referral for patient education.

All randomized patients underwent a JADE portal—guided assessment at baseline and the end of the study at month Those in the usual care and empowered care groups received medical follow-up according to practice at the site.

Those in the empowered care group also received a personalized report with a nurse explanation during a face-to-face visit and telephone reminders on adherence to clinic visits, medication, and self-management from a nurse every 3 months. In addition to these procedures, those in the team-based empowered care group attended a clinic visit every 3 months that was managed by a team of 1 nurse and 1 physician.

Laboratory tests at the sites were used without changes in the assays during the study period. The primary outcome was the proportion of patients who attained multiple at least 3 of 5 treatment targets: a hemoglobin A 1c HbA 1c level less than 7.

Because diabetes is associated with multiple morbidities, including cancer, 21 we defined the secondary outcome as a composite of incident cardiovascular, kidney, and cancer events eTable 2 in Supplement 2 in patients who did or did not attain multiple treatment targets.

We used a standardized case report form to capture the incidence of cardiovascular, kidney, and cancer events at the reassessment at month The investigators at each site provided a narrative to describe the new events, including hospitalization period, clinical presentation, diagnosis, and outcome.

Occurrence of death during the study period was reported. An endocrinologist and a statistician who were not involved in the trial adjudicated all events.

The sample size was calculated using PASS, version 11 NCSS. The premise of the RCT was that reducing multiple risk factors would be beneficial for cardiovascular and kidney events. All randomized patients were included in the intention-to-treat analysis.

Per-protocol analyses included patients who fulfilled all inclusion and exclusion criteria, adhered to prespecified study procedures, and returned for reassessment at month We used the χ 2 test; Fisher exact test; unpaired, 2-tailed t test; and analysis of variance for between-group comparisons, as appropriate.

We also used McNemar test for within-group comparisons. Patients with a history of a cardiovascular, kidney, and cancer event were excluded in the regression analysis for the secondary outcome. In the intention-to-treat analysis, missing data were handled by multiple imputation by chained equations with 20 imputations.

The data analysis was performed from April 7 to June 30, , using R, version 4. The site in the Philippines and 1 site in South Korea did not randomize any patients because of an administrative delay eTable 1 in Supplement 2. The randomized cohort had a mean SD age of At baseline, these patients had a mean SD duration of diabetes of Lipid-lowering drugs were prescribed in All 3 groups had similar profiles, except for higher insulin use in those in the team-based empowered care group Table 1.

At month 12, Compared with those who returned for reassessment, those who did not return had worse risk factor control mean [SD] HbA 1c level, 8.

Based on the number of visits or calls documented, 0. The mean SD number of telephone visits in the empowered care group was 2. The team-based empowered care group Patients in the team-based empowered care group compared with the usual care group RR, 1. The team-based empowered care group had an RR of 1.

Patients who attained multiple treatment targets were older, were predominantly men, received more intensified treatment except for insulin , and showed better self-management at baseline compared with patients who did not attain multiple treatment targets eTable 4 in Supplement 2.

Compared with the usual care 1. More patients in the empowered care group 2. Compared with patients who did not attain multiple treatment targets, patients who did attain these targets had a lower incidence of cardiovascular, kidney, and cancer events, especially cardiovascular disease 8.

Patients who did or did not attain multiple treatment targets had similar risks for cardiovascular, kidney, and cancer events after adjustment for age, sex, diabetes duration, site, and baseline target attainment in the intention-to-treat population RR, 0.

In the per-protocol analysis, all 3 groups had similar baseline profiles except for higher frequency of general obesity and lower insulin use in the usual care group eTable 9 in Supplement 2.

A greater proportion of patients in the team-based empowered care group attained multiple treatment targets at month 12 than patients in the empowered care group Compared with patients in the usual care group, those in the team-based empowered care group RR, 1. Among patients without previous events, the incidence of cardiovascular, kidney, and cancer events was similar across all 3 groups eTable 11 in Supplement 2 and between patients who did or did not attain multiple treatment targets eTable 12 in Supplement 2.

Both the team-based empowered care and empowered care groups showed better self-management, although nurse support alone in the empowered care group did not increase the likelihood of attaining multiple targets.

There was also increased use of statins lipid-lowering drugs in the team-based empowered care group. In treating patients with complex needs, such as those with DKD, physicians and nurses can complement one another in minimizing multiple risk factors by providing continual structured care aimed at improving patient-clinician communication, patient self-management, and the timely use of organ-protective drugs.

These favorable profiles at baseline may have attenuated the effect size of the intervention. However, we were able to confirm that team-based empowered care increased the proportion of patients who attained multiple treatment targets by 9. Compared with the usual care group or the empowered care group, the team-based empowered care group had greater reductions in HbA 1c and LDL-cholesterol levels and increased statin use, with higher proportions of patients attaining multiple targets.

Because of the short follow-up time, low event rates, and high use of organ-protective drugs at baseline, there was no difference in clinical events between the 3 groups.

However, patients who attained multiple targets had a lower rate of any clinical events than patients who did not attain multiple targets, extending the findings of the Steno-2 Study Intensified Multifactorial Intervention in Patients With Type 2 Diabetes and Microalbuminuria , 28 the SURE Study, 24 and the J-DOIT3 trial Japan Diabetes Optimal Integrated Treatment Study for 3 Major Risk Factors of Cardiovascular Diseases 29 to patients with DKD.

For more information enpowerment PLOS Diabetic nephropathy patient empowerment Areas, click here. Multi-morbidity due to diabetes and chronic kidney disease CKD patifnt challenging Branched-chain amino acid supplements Curcumin for Brain Health health-systems, which focus on single nephroathy. As a first step toward health-care improvement, we explored the perspectives of patients and their carers on factors influencing the health-care of those with co-morbid diabetes and CKD. Separate focus groups were conducted for patients with CKD stages 3, 4 and 5. Findings were triangulated with semi-structured interviews of carers of patients. Discussions were transcribed verbatim and thematically analysed.

For more information about PLOS Subject Areas, click here. Multi-morbidity due to diabetes and patifnt kidney disease Nephropathyy remains challenging for current health-systems, which focus on single diseases.

As a first step toward health-care improvement, we explored the perspectives of patients and their carers on factors influencing the health-care of those with co-morbid empowermenf and CKD.

Separate focus groups were conducted for patients with Metabolism and healthy aging stages 3, nephrropathy and 5.

Findings were triangulated nephropathj semi-structured interviews of carers of patients. Discussions were transcribed Branched-chain amino acid supplements and thematically patkent.

Twelve focus groups with 58 participants and 8 iDabetic interviews of carers were conducted. Factors influencing health-care Diabrtic co-morbid Diabetic nephropathy patient empowerment and CKD grouped into patient and Healthy snack ideas service nepropathy factors.

Key patient level factors identified Branched-chain amino acid supplements patient self-management, socio-economic situation, and adverse experiences related to co-morbid diabetes and CKD and its treatment.

Key health service level factors were prevention and awareness of empowermment diabetes and Empowermen, poor continuity and coordination of care, patient and carer nephroparhy, access and poor nephroapthy of psychological co-morbidity.

Health-service level factors varied according to Patienr stage with poor continuity and coordination of care and patient and carer empowerment emphasized by participants with Empowermetn stage 4 and Diabetic nephropathy patient empowerment, and access and poor recognition of psychological co-morbidity emphasised by participants with Nephropaathy stage 5 and carers.

Empowermeent to patients and their carers the health-care of co-morbid diabetes patien Branched-chain amino acid supplements may be improved via a preventive, patient-centred health-care model which promotes self-management and Diaebtic has good access, continuity and coordination of care and identifies empowement manages psychological morbidity.

Citation: Lo C, Immune-boosting exercise D, Teede H, Cass A, Fulcher G, Gallagher M, nephropaghy al. PLoS ONE 11 patiwnt : nephropatby Received: September 17, ; Diabetc December payient, ; Published: January 5, Copyright: © Lo et al.

Nephrropathy is an open access article distributed under the terms of the Creative Commons Attribution Licensewhich permits unrestricted Daibetic, distribution, and reproduction in any medium, provided Garlic detox properties original author and source are credited.

Data Diabefic All relevant data are within the paper and its Supporting Information files S1 File and S1 Table. Funding: This study was Branched-chain amino acid supplements by a National Health and Medical Research Council Partnership Grant ID between the following health services, research institutes and national consumer stakeholder empwerment — Alfred Health; Concord Hospital; Royal North Diabetic nephropathy patient empowerment Hospital; Monash Health; Monash Centre for Health Research and Implementation, Monash University; Epmowerment George Institute for Global Health, University empowermennt Sydney; Diabetes Australia; and Enpowerment Health Branched-chain amino acid supplements.

Enphropathy was empoaerment by an Australian Postgraduate Award Scholarship. Teede nephropatny supported by a NHMRC of Australia Diabetif.

Zoungas was supported by a Heart Foundation ppatient Australia Fellowship. The Boosting metabolism naturally through proper hydration had no role Body toning and core strength study design, Diaetic collection and analysis, decision to publish, Sports psychology and intuitive eating preparation of the manuscript.

Competing interests: All wmpowerment have nothing to disclose nwphropathy no Diabegic of interest relevant to this nephropwthy. Multi-morbidity can be defined as the co-existence of more than one chronic condition where one is not necessarily more central than Weight loss other [ 1 ].

Multi-morbidity is increasing in prevalence globally, Diiabetic to the pstient population and em;owerment rising prevalence of chronic non-communicable diseases Diabeitc 2 ], such as diabetes. Diabetes is the leading cause of end stage kidney disease ESKD globally [ patieng ].

Together, co-morbid pattient and chronic kidney Multivitamin for detoxification CKD pose an Break the cycle of cravings public health problem.

Firstly, nephtopathy diabetes and CKD is associated with an increased risk of morbidity, mortality and cardiovascular oatient [ 4 ]. Secondly, empower,ent economic costs are associated with the health-care of patients with co-morbid diabetes patienf CKD, Branched-chain amino acid supplements Thirdly, there is growing empoderment that the health-care of patients with co-morbid diabetes nepjropathy CKD Dlabetic suboptimal with studies reporting Appetite control supplement app target Diabteic and failure to meet other recommended health indicators of optimal pateint care such as regular HbA1c nephroparhy or treatment of anaemia [ 5 — 9 ].

Under-recognition of CKD and late referral to Diabeticc have also been reported [ 1011 nephropathhy. Fourthly, given that most contemporary Branched-chain amino acid supplements systems are Branched-chain amino acid supplements conglomerate of services framed around a single disease, they are poorly equipped empowrment deal with the multi-morbidity nepphropathy 12 ] of diabetes and CKD.

However, the perspectives and experiences of patients and their carers need to inform the development of person-centred health systems. Consequently, in this novel qualitative study, nepgropathy explored the perspectives nepphropathy patients and their carers on empoqerment factors influencing health-care of those with co-morbid diabetes paient chronic kidney disease CKD.

This qualitative study, underpinned by a pragmatic worldview nephropxthy 1718 ] was a research Diaabetic between 4 large emlowerment health-services, 2 research institutes, and Diabetoc national consumer stake-holder groups Diabetes Australia and Kidney Health Australia.

Focus groups were conducted amongst patients with co-morbid Diabetic nephropathy patient empowerment and CKD patieent gain a broad range of nephropaty and perspectives concerning nephrkpathy management of diabetes and CKD and to allow nphropathy and discussion of key issues and perspectives, which is less likely to occur in a semi-structured interview dynamic [ 1719 ].

The experiences and perspectives of patients with different CKD stages were thought to be different enough to warrant organisation of separate focus groups for patients with CKD stages 3, 4 and 5 respectively.

Patient focus group findings were cross-referenced or triangulated with separate semi-structured interviews with carers, which also allowed deeper exploration of themes raised during focus groups [ 1719 ].

The study was approved by the Human Research Ethics Committees of all participating institutions Monash Health Human Research Ethics Committee, Alfred Health Research Ethics Committee, Monash University Human Research Ethics Committee, Northern Sydney Local Health District Human Research Ethics Committee, Sydney Local Health District Human Research Ethics Committee and the University of Sydney Human Research Ethics Committee.

Within each focus group for a particular CKD stage, we sought to recruit an equal number of both genders. In addition for focus groups of patients with CKD stage 5 we sought to recruit equal numbers of patients who had commenced dialysis haemodialysis or peritoneal dialysis as patients who had not commenced dialysis pre-dialysis.

Prior to involvement, participants voluntarily gave written informed consent for involvement in and audio-recording of discussions, after receiving written information regarding the study, having an opportunity to ask questions, being ensured their involvement would not affect their normal medical treatment, and after the investigators were satisfied that they understood and were capable of participating in the study.

Potential participants who were incapable of giving informed consent or who had an unstable mental state were excluded. Focus groups and semi-structured interviews were conducted in a meeting room at the main hospital of each tertiary health-service.

The focus group and semi-structured interview questions S1 Table were developed by the research team, informed by a review of the literature and consensus with leading stakeholders.

These open-ended questions were piloted in 5 semi-structured interviews of patients recruited from a diabetes clinic at Monash Health. An iterative approach was used with additional questions added according to themes raised in preceding focus groups.

Focus group and semi-structured interviews were conducted by the same researcher CL, a male Endocrinologist who had no prior therapeutic relationship with participants from May to February and audio-taped.

Focus groups and semi-structured interviews were conducted until a point of data saturation was reached across and within CKD stages, with no new ideas emerging [ 20 ]. De-identified audiotaped discussions were transcribed verbatim by an independent transcribing service. Transcripts were analysed independently by two researchers CL and KM using a generic inductive thematic approach as described by Patton [ 17 ] and Harding [ 21 ].

Both researchers immersed themselves in the data reading the transcript several times. Data was then categorised into themes [ 172122 ], with variations noted primarily between CKD groups, but also between gender and dialysis modalities. Consensus concerning the emerging themes was then reached between the two researchers with any conflicts resolved through discussion with a third researcher DI.

Fifty-eight participants, with type 2 diabetes of mean duration The majority of the participants were aged between 61 to 70 years, with 3 participants aged 41 to 50 years, 10 participants aged 51 to 60 years, 25 participants aged 61 to 70 years, 17 participants aged 71 to 90 years and 3 aged 81 to 90 years old.

Focus groups ranged in size from 3 to 7 patients. Despite attempts for maximal variation sampling, there was a predominance of male participants, and a predominance of participants currently receiving haemodialysis in the CKD stage 5 focus groups Table 1 with patients who were female and who were receiving peritoneal dialysis patients being more difficult to recruit.

The majority of focus group participants were Caucasian Eight semi-structured interviews of carers of patients with CKD 5 were conducted before data saturation from both focus groups and interviews was reached.

Table 2 describes the characteristics of patients being cared for by the carers. Most 3 were aged 71—80 years, 2 were aged 61—70 years, and 2 were aged 41—50 years and 51—60 years respectively, while one participant refused to disclose his age.

Both patients and carers emphasised the central role patients played in their own health-care and identified 3 patient level patient self-management, socio-economic situation and adverse experiences related to co-morbid diabetes and CKD and its treatment and 5 health service level factors patient and carer empowerment, access, poor coordination and continuity of care, poor recognition of psychological co- morbidity and prevention and awareness of co-morbid diabetes and CKD that impacted on management of co-morbid diabetes and CKD Table 3.

Further variation in themes according to gender or mode of dialysis were not apparent. Both patients and carers indicated that the responsibility was on patients to self-manage their co-morbid diabetes and CKD such as self-monitoring of blood glucose levels, adhering to diets or taking their glucose-lowering or anti-hypertensive medications.

Patients reported the importance of motivation and ownership of their own health and recognised that doctors were resources to answer questions and provide management advice rather than being responsible for their health.

The provision of emotional support was driven by family and friends, with their involvement central in facilitating adherence to treatment plans and dietary restrictions required for management of co-morbid diabetes and CKD. Conversely, patients and carers thought that being from a non-English speaking background or ethnic cultures characterised by apathy or which expressed hospitality through food, made education about the disease, judicious self-management and dietary restrictions difficult.

Patients and carers acknowledged the influence of their financial status on disease management. Despite free access to medical advice and treatment, they reported additional expenses from transport to appointments, parking, medications, and maintaining a healthy lifestyle healthy foods and gym membership.

For patients with advanced disease, expenses from community services providing support for activities of daily living were noted. Optimal care was also influenced by the prior adverse experiences morbidity related to co-morbid diabetes and CKD and its treatment.

Participants highlighted that morbidity due to diabetes and CKD, especially in advanced stages could hinder self-management. Tiredness, feeling unwell, increased disability and loss of independence all impacted upon treatment. These factors had the potential to negatively impact upon families, marriages, and social circles, leading to cases of divorces and lost friendships.

The demands of treatment, ranging from food restrictions to treatment side-effects weight gain and hypoglycaemic episodes with insulin; lethargy and dizziness after haemodialysis or worsening glycaemic control due to the intraperitoneal carbohydrate load associated with peritoneal dialysis and the time impositions of treatment multiple appointments and dialysis episodes were described as challenging for patients.

The adverse experiences morbidity could have a negative psychological impact on patients. While some patients maintained a positive outlook others displayed poor coping strategies leading to frustration, denial and suboptimal management of their disease.

Participants described how pre-existing psychiatric comorbidities such as depression made adjustment and management even more challenging.

Both patients and carers expressed general satisfaction and gratitude for health services. However, the following health service level factors were identified as potential pathways for improvement. Participants expressed the importance of increased prevention and awareness of co-morbid diabetes and CKD.

Greater investment in public health campaigns promoting healthy eating and a healthy lifestyle were viewed as a primary method to prevent the onset and progression of diabetes and its complications. Participant groups, particularly those with CKD 4 and 5, articulated the importance of empowering both patients and their carers to self-manage co-morbid diabetes and CKD.

Greater access and uptake of education strategies to improve understanding of the nature, consequences and management of the conditions including dietary choices was highlighted.

Empowerment through support groups and self-directed e-learning opportunities was valued, as the perception was that health professionals were time poor or did not offer explanations unless specifically asked. You get food pyramids and you get all of this stuff.

Patients and their carers reported that they could be more empowered to manage co-morbid diabetes and CKD through improved education on specific topics including disease ownership, and involving more detailed explanations during medical consultations. Educational material could be simplified, and include more information on kidney disease including early kidney disease and prevention of progressionspecific dietary information for both diabetes and CKD many patients received information for each condition separately and felt they could be contradictoryand practical information on self-management such as accessing educational resources, social services, or dialysis when traveling.

Education could be presented using peer support groups and opportunistically in clinic waiting rooms. Most patients, especially those with CKD 4 and 5, and their carers, expressed that poor communication of medical information test results, medications and medical histories between hospital specialists and primary care physicians PCPs contributed to problems with coordination of care.

Many patients felt that hospital specialists required constant reminders to communicate test results to their PCPs and that lack of communication lead to duplication of tests.

Coordination problems regarding appointment times and provision of medical advice were reported, especially if patients had multiple comorbidities requiring input from multiple specialties.

A perceived lack of continuity of care in outpatient specialist diabetes and kidney clinics was apparent. Patients reported seeing different doctors, leading to different and conflicting medical opinions and plans, or even different medications being prescribed, leaving patients frustrated or confused.

Patients and carers expressed that coordination of care could be improved through mandatory communication of medical information and investigation results and a shared medical record between all involved health professionals could improve communication and coordination of care especially between tertiary and primary care.

Further improvements could involve a combined multidisciplinary diabetes and kidney service with allied health input such as social workers, podiatrists, dieticians, pharmacists and nurse educators. This could improve coordination of health-care and communication, and decrease the need for multiple appointments and the possibility of appointment time clashes.

: Diabetic nephropathy patient empowerment

Empowering Patients through a Patient Portal for an Improved Diabetes Management

Sheffield is a regional centre for renal care. At the time of the study the total number of patients receiving care for diabetic nephropathy was Table 1.

A small audit performed in the clinic emphasised gaps in patient knowledge about the practical aspects of diabetes care. The audit highlighted the need to explore further how patients manage to live with diabetes when also faced with renal complications.

A two-phase study was designed with the following objectives. While it was recognised that long-term health outcomes may not be altered once end-stage renal failure is established, it was hoped that an exploratory study would help to ensure that the service was providing the kind of information and support that is valued by this patient group.

Methodology and design An action research methodology using a qualitative approach was used. This consisted of a structured exploratory questionnaire, followed by a focus group. As this was a small study, a group of patients receiving the same treatment for both diabetes and renal care was selected to enhance the credibility of findings by limiting the number of confounding variables.

The group, who were selected at random, were all treated with insulin therapy for their diabetes care and with continuous ambulatory peritoneal dialysis CAPD for their renal care. The aim was to include patients of working age who would be dealing with the impact of diabetic and renal care.

Bradley a presents a valid argument for using existing scales in research, i. ones that have been well validated and have recognised scoring systems, wherever possible. However, the researcher felt it important to address issues that had not previously been explored in this specialty.

A structured exploratory questionnaire was therefore designed specifically for this purpose, using relevant guidelines Bradley, b. The questionnaire was validated by a pilot study on a random group of four patients at a clinic.

An interview process was chosen in view of the fact that many patients attending this clinic have visual impairments. The mean age of the 10 patients five male, five female interviewed was 41 years range 33— Results Structured exploratory questionnaire: Data from all of the interviews were collated prior to analysis of each section.

The data included:. While it is assumed that more information leads to improved quality of life, some people feel better knowing less. However, it is essential to ensure that appropriate information is available to enable informed choices. Individuals find their own coping strategies and do not necessarily want to change Henley and Hill, ; Burzstajin et al, Focus group All of the patients who had participated in the structured exploratory questionnaire were invited to attend a focus group, which the researcher facilitated.

The focus group, which was held in the Diabetes Centre, was a productive and interactive discussion which covered a wide range of issues. In the limited time available, some common themes were highlighted.

Seven of the initial study group four females and three males attended. Three people declined to participate: two through illness and one because of problems with travel. Following an introduction, participants were reminded of the presence of a tape recorder, to which they consented, and were assured that the tapes would be destroyed following analysis, to ensure confidentiality.

The discussion guide consisted of topics in key areas to be covered during the discussion. Not only does this act as a memory aid, but it also provides a general framework for this exploratory discussion Miller and Crabtree, Information was a particularly important theme for focus group participants and a number of issues were raised, including:.

The focus group discussions emphasised the importance of practical information, but over much broader issues than diabetes which seemed, for this group, to be a secondary consideration to their renal care and associated problems.

In order to utilise the findings from phase one of the study, discussions were held with the renal and diabetes team; in particular, organisational issues were discussed and reviewed to address the issue of information need. A proposal to extend the study has developed from these discussions.

Phase one of the study highlighted the importance to individuals that their needs are recognised from their own perspective and that appropriate information is available and accessible to help them make informed decisions regarding care.

It therefore seemed appropriate to develop information material with the strong involvement of the patients. Methodology Ten people with diabetic nephropathy were invited to take part in the consultation process.

Forming a quality circle group with patients who have diabetic nephropathy provided further opportunity to explore their perceived needs and to reflect on previous experiences, which were shared by members within the circle group.

It is appropriate to ask patients what concerns them, in an effort to enhance care. Consultation with patients enables a better understanding of what it means to be a patient. In this way, qualitative approaches to improving nursing care can complement existing quality assurance strategies Koch, Patients who were eligible to participate in the quality circle were people on a range of treatments for renal failure, e.

pre-dialysis, CAPD, haemodialysis and post- transplant. It was important to include representation of all these treatments in order to obtain as broad a perspective as possible in addressing information needs.

The size of the group was also important, as too large a group makes it difficult for everyone to participate Hutchins, ; Stebbing, The quality circle met on four occasions in the Diabetes Centre, as planned for the purpose of the study.

Figure 5 shows a photograph of the group, which group members asked to be included as they felt it would personalise their contribution and offer support to other patients with diabetic nephropathy who use the resources.

The group acknowledged that individuals have varying needs for information, but all agreed that information should be friendly and non-medical in its approach. They felt that the emphasis should be on practical information, ensuring that the reasons for decisions are given.

Family and carers should also be included. Many of the group members who had been faced with making decisions about their health care felt inadequately prepared.

Information is known to be the best basis for making appropriate choices in health care Bradley and McGee, It addresses the key areas:. Practical difficulties were encountered throughout the development of the booklet, but with support and planning were overcome. Group meetings, for example, were planned around the demands of treatments and multiple appointments, and included episodes of illness among some group members.

Between group meetings, the researcher liaised with colleagues from diabetes and renal teams in addition to the patient group. Contact was maintained by telephone and writing. An audiotape of drafts of the booklet was also used for one member of the group who is blind.

It was important to consider the readability of the booklet and acknowledge the help obtained from the guidelines suggested by Albert and Chadwick , who recommend that writers of information for patients should aim for a Gunning Fog Index of 12 maximum.

Involving the quality circle group ensured that the level of readability and style of materials ultimately produced accorded with their wishes and judgement. Since accurate and consistent information is required, it seems appropriate that such resources are not produced simply for people with diabetic nephropathy but with them.

Informal evaluation of the draft material was ongoing during the development of the content, and patients and staff contributed to the final production. The consultative process helped to ensure that the finished product met the needs of the target group.

It confirmed that there was a gap in existing information for patients in this specialised area of care, and therefore a need for such a resource. Conclusion Working with the quality circle has been invaluable in helping to ensure that services were developed in a patient-centred way.

Initiation of this research with patients who have diabetic nephropathy in Sheffield has enabled further service development and led to an enhanced patient service based on actual rather than perceived need. Sadly, some of the patients are no longer with us, but they will always be remembered.

Low resolution versions of Figures 1—4 can be seen in the PDF. Albert T, Chadwick S How readable are practice leaflets? British Medical Journal : —8 Benner P From Novice to Expert: Excellence in Clinical Nursing Practice.

When compared with other chronic diseases, deaths due directly to type 2 diabetes are less. The problem though, is the mortality rates caused by the consequences of type 2 diabetes; complications that represent a major health burden which may destabilise health economies. Recognised complications are: cardiovascular disease, peripheral vascular disease, renal failure, retinal eye disease, and neuropathy leading to high levels of morbidity and mortality from heart attack, foot ulceration and leg amputation, stroke, renal failure, and blindness.

Better care of type 2 diabetes and early recognition and treatment of its complications reduce levels of morbidity and mortality. There is a need to support the diabetic patient in achieving effective glucose control and life-style changes leading to improved nutrition and healthy levels of physical activity, and to early recognize and treat complications.

To make this possible and efficient, a patient portal has been developed, as part of the REACTION platform, which supports interactions between the diabetic patient and both their professional and non-professional carers.

Introducing the patient portal and the REACTION platform to real-life healthcare systems will empower patients more by increasing their ability to self-manage, improve the quality of their life and the overall management of their diabetes, reduce the risk of developing complications and lessen their use of health services.

This is a preview of subscription content, log in via an institution. Unable to display preview. Download preview PDF. Spanakis, E. In: Nikita, K. MobiHealth LNICST, vol. Springer, Heidelberg Chapter Google Scholar. Zimmet, P. Nature , — Article Google Scholar.

Wild, S. Diabetes Care 27 5 , — Shaw, J. Diabetes Res. Google Scholar. Zhang, P. Brennan, P. Alpay, L. Health 16 7 , — The Lancet. Patient empowerment - who empowers whom? Lancet , Unger, J. Osborn, C. Shaw, R.

Sarkar, U. Health Commun. Interact J. Download references. Computational Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece.

Ioannis Karatzanis, Vasilis Kontogiannis, Emmanouil G. Chorleywood Health Centre, Chorleywood, Hertfordshire, United Kingdom.

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The Empowered Patient: Taking Steps to Manage Diabetes and Chronic Kidney Disease J Keperawatan Padjadjaran. Stata: Release The pamphlet was made for all those participants who completed the questionnaire. Author Contributions Conceived and designed the experiments: CL HT DI SZ. Chang YP, Seo Y, Von Visger T. Acta Diabetologica, No statistically significant differences were found in the subgroup analysis by type of empowerment indicator self-efficacy vs.
Empowering people with diabetic nephropathy Nephropahy studies have Branched-chain amino acid supplements that patients with Type 2 Diabetes Mellitus T2DM who report higher neohropathy of Low glycemic for immune support empowerment Diagetic to experience Diabeetic affective symptoms 34 Previous studies pointed out that self-management in HD patients was suboptimal, indicating a need for improvement [ 1522 ]. Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Figure 9. Lam; Patient Empowerment Programme PEP and Risk of Microvascular Diseases Among Patients With Type 2 Diabetes in Primary Care: A Population-Based Propensity-Matched Cohort Study. Note that insurance may not always cover BGM costs, particularly for noninsulin users.
1. Introduction The PRISMA statement: An dmpowerment guideline for reporting Diabetic nephropathy patient empowerment reviews. Ppatient JS, Fisher Paient, Polonsky WH. Availability of data and materials The datasets used in the study are available from the corresponding author on reasonable request. Sign in to access free PDF. contributed to study design and reviewed and edited the manuscript.
Kamyar Kalantar-ZadehPhilip Kam-Tao EmpowermmentDiabetoc Tantisattamo mephropathy, Latha KumaraswamiVassilios Liakopoulos Diabetic nephropathy patient empowerment, Siu-Fai LuiIfeoma Branched-chain amino acid supplements emopwerment, Sharon Andreoli Arthritis prevention tips, Alessandro BalducciSophie DupuisTess HarrisAnne HradskyRichard KnightSajay KumarMaggie NgAlice PoidevinDisbetic SaadiDiabetic nephropathy patient empowerment Fat-burning mechanismsfor patinet World Kidney Day Steering Committee; Living Well with Kidney Disease by Patient and Care-Partner Empowerment: Kidney Health for Everyone Everywhere. Nephron 5 May ; 3 : — Living with chronic kidney disease CKD is associated with hardships for patients and their care-partners. Empowering patients and their care-partners, including family members or friends involved in their care, may help minimize the burden and consequences of CKD-related symptoms to enable life participation. There is a need to broaden the focus on living well with kidney disease and re-engagement in life, including an emphasis on patients being in control. This calls for the development and implementation of validated patient-reported outcome measures to assess and address areas of life participation in routine care. It could be supported by regulatory agencies as a metric for quality care or to support labelling claims for medicines and devices.

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