Kidney Care during COVID-19 in the UK: Perspectives of Healthcare Professionals on Impacts on Care Quality and Staff Well-Being

In light of the rapid changes in healthcare delivery due to COVID-19, this study explored kidney healthcare professionals’ (HCPs) perspectives on the impact of these changes on care quality and staff well-being. Fifty-nine HCPs from eight NHS Trusts across England completed an online survey and eight took part in complementary semi-structured interviews between August 2020 and January 2021. Free-text survey responses and interviews were analysed using inductive thematic analysis. Themes described the rapid adaptations, concerns about care quality, benefits from innovations, high work pressure, anxiety and mental exhaustion in staff and the team as a well-being resource. Long-term retention and integration of changes and innovations can improve healthcare access and efficiency, but specification of conditions for its use is warranted. The impact of prolonged stress on renal HCPs also needs to be accounted for in quality planning. Results are further interpreted into a theoretical socio-technical framework

Patient activation and its association with symptom burden and quality of life across the spectrum of chronic kidney disease stages in England

Background: The knowledge, skills, and confidence to manage one’s own health is termed patient activation and can be assessed using the Patient Activation Measure (PAM). This measure is increasingly recommended for use in chronic kidney disease (CKD), but there is a need to better understand patient activation within this population. This work aimed to explore the association of PAM with patient-reported outcomes, namely symptom burden and health-related quality of life (HRQoL), to understand the relationship between patient activation and outcomes which are of importance to people with CKD. Methods: Non-dialysis, dialysis, and kidney transplant patients from 14 renal units across England completed a survey comprising questionnaires assessing patient activation, symptom burden, and HRQoL. Latent class analysis (LCA) was used to determine HRQoL and symptom burden subgroups in the data. Multinomial logistic regression analyses were performed to investigate the associations between patient activation and symptom burden and HRQoL classes separately, adjusting for age, gender, ethnicity, deprivation and treatment modality. Results: Three thousand thirteen participants (mean age 61.5 years, 61.8% males, and 47% haemodialysis) were included in the analysis. Patient activation was strongly associated with both the HRQoL and symptom burden classes identified, with highly activated patients more likely to report higher HRQoL (P =  Conclusion: Lower activation levels are associated with a higher symptom burden and reduced HRQoL across the trajectory of CKD stages and treatment modalities. Therefore, targeted and holistic self-management support focussing on improving activation may have the potential to improve aspects of health experience which are valued by individuals living with kidney disease.</p

Characteristics of study interventions and outcomes.

Characteristics of study interventions and outcomes.</p

Visual representation of reported effect direction of dietary and lifestyle mobile applications on participant reported outcomes.

Visual representation of reported effect direction of dietary and lifestyle mobile applications on participant reported outcomes.</p

Criteria used to assess the quality of the included studies.

Criteria used to assess the quality of the included studies.</p

Visual representation of reported effect direction of dietary and lifestyle mobile applications on clinical outcomes.

Visual representation of reported effect direction of dietary and lifestyle mobile applications on clinical outcomes.</p

Characteristics of included studies, process evaluations and developmental studies.

Characteristics of included studies, process evaluations and developmental studies.</p

Quality rating for the uncontrolled before-after studies.

Overall rating was rated as poor (0–4 as “yes”), fair (5–8 as “yes”), as good (9–12 as “yes”). A “fatal flaw” was defined as “no” for either questions 5 or 9.</p

Visual representation of reported effect direction of short messaging service (SMS) on participant reported outcomes.

Visual representation of reported effect direction of short messaging service (SMS) on participant reported outcomes.</p

Quality rating for the cohort and cross-sectional studies.

Overall quality rating was rated as poor (0–4 as “yes”), fair (5–10 as “yes”), as good (11–14 as “yes”).</p