Maintaining a viable vascular access for hemodialysis in an elderly person with diabetes : a journey to live, not just to stay alive

The longevity of a successful vascular access (VA) is enhanced when the care of the patient's VA is the responsibility of everyone involved, including the patient and their family. A family nursing perspective enhances VA care outcomes and increases quality of life and well-being for patients requiring hemodialysis. The longevity of a successful vascular access (VA) is enhanced when the care of the patient's VA is the responsibility of everyone involved, including the patient and their family. A family nursing perspective enhances VA care outcomes and increases quality of life and well-being for patients requiring hemodialysis

Care of a patient's vascular access for haemodialysis: A narrative literature review

Background: Patients requiring haemodialysis have diverse clinical needs impacting on the longevity of their vascular access and their quality of life. A clinical practice scenario is presented that raises the potential of unsafe cannulation of a patient's vascular access as a result of minimal patient empowerment. Vascular access care is the responsibility of everyone, including the patient and carer. Aim: The aim of this narrative literature review (1997-2014) is to explore the current understanding of what factors influence the care of vascular access for haemodialysis. Method: A narrative literature review allows the synthesis of the known literature pertinent to the research question into a succinct model or unique order to enable new understandings to emerge. The bio-ecological model was used to guide the thematic analysis of the literature. Results: The narrative literature review revealed five themes related to care of vascular access: patient experience; relationships-empowerment and shared decision making; environment of healthcare; time; and quality of life as the outcome of care. Conclusion: The management of vascular access is complicated. Current available literature predominantly concentrates on bio-medical aspects of vascular access care. Contextualised vascular access care in the complex ecology of the patient and carer's lives has the potential to enhance nursing practice and patient outcomes. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association

Retrospective analysis of telemonitoring in Wollondilly, Australia

Purpose: The purpose of this paper is to analyse early findings from telemonitoring data for chronic obstructive pulmonary disease patients, residing in Wollondilly Shire, New South Wales, Australia. The Shire has 19 small scattered and isolated rural communities, which experience undersupply of healthcare providers. Findings are to be used for further research to support wider implementation of telemonitoring by general practitioners (GPs). Design/methodology/approach: Local patients with multiple chronic obstructive pulmonary disease hospital admissions were allocated home telemonitoring equipment, entering readings according to their GP management plan. Demographic, biometric and self-assessment readings were retrospectively collected, from July 2015 to April 2016. Findings: Data for 18 patients aged 44-87, with equal gender representation was analysed. There was a total of 24,545 data points from 2,932 readings. Over half showed high clinical risk; 93 occasions required GP escalation, 23 per cent for respiratory conditions, in 14 patients. Nine were hospitalised, 51 per cent for respiratory conditions. Practical implications: Home telemonitoring of chronic obstructive pulmonary disease was found to be a promising patient management approach, providing accurate, reliable health indicators. Its use empowered patients to improve symptom control and health outcomes. Originality/value: Experience in Australian general practice with telemonitoring is limited. High protocol compliance occurred, risk indicators were obtained and the value of home telemonitoring was confirmed

A multi-centre observational study of how financial considerations influence dialysis treatment decisions

Introduction Little is known about the factors that contribute to the successful uptake of home dialysis, although increased utility costs have been identified as one possible factor affecting the decision to take up home dialysis. This paper reports on quantitative survey data collected during an Australian multi-centre observational study that aimed to identify factors that either facilitate or inhibit the uptake of home dialysis from patients' perspectives. Method This paper provides a quantitative analysis of survey responses that dealt with the question of how cost is experienced by those on dialysis, whether home or hospital. 138 participants were recruited from five dialysis centres. All forms of dialysis treatment were included. The survey was purposely designed to gain insight into how home dialysis is perceived and/or experienced. Survey responses were counted, ranked and summarised. Result Quantitative measures reported in this paper identify obstacles and facilitators to home dialysis. While costs were a concern for some home dialysis patients, cost alone did not explain treatment decisions. Support and medical advice were reported as more common factors affecting treatment decisions. Discussion & Conclusion The quantitative analysis of results shown in this paper indicates that cost does not determine treatment decisions for these dialysis patients in Australia. This finding lends support to at least maintaining the financial support offered to Australian patients as they prepare for home dialysis. Ongoing costs were documented and the results shown here provide justification for additional assistance in the form of payouts to dialysis patients on low incomes

HealthPathways implementation on type 2 diabetes : a programmatic evaluation (HIT2 evaluation)

Purpose: The purpose of this paper is to appraise the development, implementation and acceptance of HealthPathways (HP), specifically in Type 2 Diabetes Mellitus (T2DM), at different levels of the health system in a large metropolitan Local Health District in Australia. Design/methodology/approach: This study used a programmatic approach and mixed methods including literature reviews, site visits, semi-structured interviews of stakeholders and General Practitioners (GPs), and surveys (GPs and patients) to better understand the development, implementation and acceptance of T2DM pathways. Findings: Results from this study indicate that 63 percent (n=37) of all survey respondents use HP and nearly half (47 percent) use HP in caring for a patient with diabetes. More than 80 percent of the health professionals found HP a useful tool, which has improved the quality of care, keeps them informed and supports diagnostics process. The use of website has led to an improvement in referral quality (69 percent), has assisted in the provision of more healthcare in the community (87 percent) and made their job easier. Thematic analysis from stakeholder interviews (n=12) emphasizes the importance of established collaborations and the need for standardized tools with common priorities and transparency in processes. Practical implications: This study has provided insight into the details of delivery of integrated healthcare using HP. It provides a preliminary analysis of the lessons learnt for the implementation of HP. Originality/value: The results of this study will be ideally placed to inform future policy amendments in the area of integrated healthcare as well as serving as a guide on implementing HP in the future

Understanding the general practice of telemonitoring integrated care : a qualitative perspective

Developed in partnership with GPs, a new telehealth model of care using remote monitoring, known as telemonitoring (TM), was introduced in South Western Sydney (SWS) in 2015, transmitting clinical readings taken at home to telehealth coordinators. This study explored the experiences, beliefs and attitudes of general practice staff to identify barriers to and facilitators of the SWS TM model. Responses were collected from a purposive sample of 10 participants via semistructured interviews (n = 9 interview sessions) and the resulting transcripts were analysed thematically. Four themes were identified: Lack of understanding and involvement; patient-centred care and empowerment; clinical practice and process factors; and system-wide communication and collaboration. Participants recognised some actual and potential benefits of TM, but barriers to TM were identified across all themes. Feedback provided by participants has informed the ongoing formulation of a more 'GP-led' model of TM

Beyond dialysis - Telehealth initiatives

Background In August 2009, Australia's HOME Network was established as a national initiative to engage and empower health care professionals working in the home dialysis specialty. The aim was to develop solutions to advocate for and ultimately increase the use of home dialysis across Australia. Emerging telehealth (technology) initiatives were identified as potential facilitators for home dialysis. Aim The aim of this paper is to develop a Position Paper on Telehealth for Renal Dialysis that is based on a review of the latest developments in telehealth services in home dialysis and other clinical areas within Australia. Methods In early 2014, the HOME Network Technology Working Group conducted a literature review to determine the opportunities for telehealth utilisation in home dialysis. Prior to considering how to advance the use of telehealth in home dialysis within Australia, the HOME Network members undertook a survey to collate information on how many home training units in Australia were using telehealth opportunities and to determine what hurdles there may be to the initiation of telehealth utilisation. Results There are limited publications about telehealth used in Australia to advance patient care in home dialysis. However, innovations have been reported informally as emerging from a number of home dialysis programs/units around Australia. Conclusion The information reported in this paper will support and drive greater collaboration with respect to the use of telehealth, and a broader awareness about the possibilities available that allow us to provide better support to all Australian home dialysis patients

Understanding of advance care planning in primary care : a gap analysis

Background: Although primary care is a well suited context for conducting advance care planning (ACP), there are many barriers to initiating discussions regarding future health preference and end-of-life conversations. Methods: This qualitative study conducted 30 detailed individual interviews with senior administrators, medical and nurse practitioners of a local health district, NSW Ambulance, e-Health NSW, general practitioners and practice nurses to find out about barriers to ACP in South Western Sydney. Results: Thematic analysis was conducted on the interviews. Six major themes were identified: Prevalence; Empowerment of roles and responsibilities; Lack of training/knowledge/confidence; Fragmentation of care; Patient/family readiness; and Prognostication. Half of the participants were willing to use a prognostic tool to identify when a patient was likely to be at the end of their life and provide a prompt to initiate ACP. Conclusion: In addition to addressing training and acknowledging resource constraints, these findings suggest that if a prognostic tool was validated and practical in a primary care setting, it may provide valuable assistance to encourage everyone in society to begin discussing this issue and completing ACP