How accessible are interpreter services to dialysis patients of Non-English Speaking Background?

Background. Benefits of utilising professional interpreters in clinical settings have been well documented. However, not many studies have focused on use of professional interpreters by dialysis patients of Non-English Speaking Background (NESB) who are in the clinical settings every second day of their lives. The underlying question for this research was to determine the level of interpreter utilisation by dialysis patients of NESB at a major urban teaching hospital. Method. A multi-method approach was used involving (a) in-depth interviews of health care professionals working with dialysis patients to elicit their views regarding interpreter access and use by dialysis patients of NESB, (b) observations of interactions between staff and dialysis patients of NESB and (c) review of medical records belonging to dialysis patients of NESB who were admitted 24 months prior to the study.Results. Interviews revealed that only 50% of Health Care Workers (HCWs) had accessed an interpreter for dialysis patients of NESB over a period of six months. Observations of staff/NESB patient interactions showed that professional interpreters were used in only 25% of the observed occasions. There view of medical records revealed that there was no evidence of interpreter use in 32% of the records belonging to dialysis patients of NESB. The study also showed that non-compliance with dialysis treatment regime was more likely to occur among patients who had limited access to interpreters. Conclusion. The study demonstrated a suboptimal utilisation of interpreter services by dialysis patients of NESB. Several barriers to inaccessibility and underutilisation of professional interpreters were identified. Recommendations to improve communication between HCWs and dialysis patients of NESB are suggested

The association between patient activation and self-care practices: a cross-sectional study of an Australian population with comorbid diabetes and chronic kidney disease

Objective: This study aimed to examine the association between performance of self‐care activities and patient or disease factors as well as patient activation levels in patients with diabetes and chronic kidney disease (CKD) in Australia. Methods: A cross‐sectional study was conducted among adults with diabetes and CKD (eGFR <60 mL/min/1.73m2) who were recruited from renal and diabetes clinics of four tertiary hospitals in Australia. Demographic and clinical data were collected, as well as responses to the Patient Activation Measure (PAM) and the Summary of Diabetes Self‐Care Activities (SDSCA) scale. Regression analyses were performed to determine the relationship between activation and performance of self‐care activities. Results: A total of 317 patients (70% men) with a mean age of 66.9 (SD=11.0) years participated. The mean (SD) PAM and composite SDSCA scores were 57.6 (15.5) % (range 0‐100) and 37.3 (11.2) (range 0‐70), respectively. Younger age, being male, advanced stages of CKD and shorter duration of diabetes were associated with lower scores in one or more self‐care components. Patient activation was positively associated with the composite SDSCA score, and in particular the domains of general diet and blood sugar checking (P<.05), but not specific diet, exercising and foot checking. Conclusion: In people with diabetes and CKD, a high level of patient activation was positively associated with a higher overall level of self‐care. Our results identify subgroups of people who may benefit from tailored interventions to further improve their health outcomes. Further prospective studies are warranted to confirm present findings.Edward Zimbudzi, Clement Lo, Sanjeeva Ranasinha, Peter G Kerr, Kevan R Polkinghorne, Helena Teede ... et al

Patient reported barriers are associated with low physical and mental well-being in patients with co-morbid diabetes and chronic kidney disease

BACKGROUND:Little is known about how patient reported barriers to health care impact the quality of life (HRQoL) of patients with comorbid disease. We investigated patient reported barriers to health care and low physical and mental well-being among people with diabetes and chronic kidney disease (CKD). METHODS:Adults with diabetes and CKD (estimated Glomerular Filtration Rate < 60 ml/min/1.73m2) were recruited and completed a questionnaire on barriers to health care, the 12-Item HRQoL Short Form Survey and clinical assessment. Low physical and mental health status were defined as mean scores < 50. Logistic regression models were used. RESULTS:Three hundred eight participants (mean age 66.9 ± 11 years) were studied. Patient reported 'impact of the disease on family and friends' (OR 2.07; 95% CI 1.14 to 3.78), 'feeling unwell' (OR 4.23; 95% CI 1.45 to 12.3) and 'having other life stressors that make self-care a low priority' (OR 2.59; 95% CI 1.20 to 5.61), were all associated with higher odds of low physical health status. Patient reported 'feeling unwell' (OR 2.92; 95% CI 1.07 to 8.01), 'low mood' (OR 2.82; 95% CI 1.64 to 4.87) and 'unavailability of home help' (OR 1.91; 95% CI 1.57 to 2.33) were all associated with higher odds of low mental health status. The greater the number of patient reported barriers the higher the odds of low mental health but not physical health status. CONCLUSIONS:Patient reported barriers to health care were associated with lower physical and mental well-being. Interventions addressing these barriers may improve HRQoL among people with comorbid diabetes and CKD.Edward Zimbudzi, Clement Lo, Sanjeeva Ranasinha, Gregory Fulcher, Martin Gallagher, Stephen Jan, Peter G. Kerr, Helena J. Teede, Kevan R. Polkinghorne, Grant Russell, Rowan G. Walker, and Sophia Zounga

Health-related quality of life among patients with comorbid diabetes and kidney disease attending a codesigned integrated model of care: a longitudinal study

OBJECTIVE:To evaluate the impact of an integrated diabetes and kidney disease model of care on health-related quality of life (HRQOL) of patients with comorbid diabetes and chronic kidney disease (CKD). RESEARCH DESIGN AND METHODS:A longitudinal study of adult patients (over 18 years) with comorbid diabetes and CKD (stage 3a or worse) who attended a new diabetes kidney disease service was conducted at a tertiary hospital. A questionnaire consisting of demographics, clinical data, and the Kidney Disease Quality of Life (KDQOL-36) was administered at baseline and after 12 months. Paired t-tests were used to compare baseline and 12-month scores. A subgroup analysis examined the effects by patient gender. Multiple regression analysis examined the factors associated with changes in scores. RESULTS:179 patients, 36% of whom were female, with baseline mean±SD age of 65.9±11.3 years, were studied. Across all subscales, HRQOL did not significantly change over time (p value for all mean differences >0.05). However, on subgroup analysis, symptom problem list and physical composite summary scores increased among women (MD=9.0, 95% CI 1.25 to 16.67; p=0.02 and MD=4.5, 95% CI 0.57 to 8.42; p=0.03 respectively) and physical composite scores decreased among men (MD=-3.35, 95% CI -6.26 to -0.44; p=0.03). CONCLUSION:The HRQOL of patients with comorbid diabetes and CKD attending a new codesigned, integrated diabetes and kidney disease model of care was maintained over 12 months. Given that HRQOL is known to deteriorate over time in this high-risk population, the impact of these findings on clinical outcomes warrants further investigation.Edward Zimbudzi, Clement Lo, Sanjeeva Ranasinha, Helena Teede, Tim Usherwood, Kevan R Polkinghorne ... et al

Contamination Of Hospital Chart Covers

BackgroundVancomycin-resistant enterococci (VRE) have been increasingly associated with patients with renal failure attending large metropolitan teaching hospitals. Monash Medical Center has been following guidelines issued by the Department of Human Services to reduce the spread of VRE, but unfortunately this has had limited impact, especially in the renal unit. In an attempt to investigate the causes of the sustained VRE prevalence in the renal unit, this study sought to determine if renal patient chart covers were contaminated with VRE and if there was any genetic similarity to patient VRE isolates.Method  Using convenience sampling, chart covers of patients colonised or infected with VRE were swabbed from July to September 2010 (n=46). Samples were also collected from chart covers of non-VRE patients. Molecular typing of all matching VRE patient and chart isolates was performed using pulsed field gel electrophoresis (PFGE) by the public health laboratory (Microbiological Diagnostic Unit, University of Melbourne). ResultsNone of the patients who were VRE negative (n=14) had contaminated chart covers. VRE was recovered from two drug chart covers (patient A and B) from the 31 VRE positive patients sampled. One patient (patient C) was misidentified as a VRE patient for two weeks and was subject to contact precautions while being dialysed, yet three chart types belonging to this patient were found to be contaminated with VRE.ConclusionThe findings of this study demonstrate that it is possible for patients’ hospital chart covers to be contaminated with VRE even though there was no genetic similarity to the current patient strain. In this regard, the study reveals that patient charts may have an important role in spreading VRE

Stemming the impact of health professional brain drain from Africa: a systemic review of policy options

Africa has been losing professionally trained health workers who are the core of the health system of this continent for many years. Faced with an increased burden of disease and coupled by a massive exodus of the health workforce, the health systems of many African nations are risking complete paralysis. Several studies have suggested policy options to reduce brain drain from Africa. The purpose of this paper is to review possible policies, which can stem the impact of health professional brain drain from Africa. A systemic literature review was conducted. Cinahl, Science Direct and PubMed databases were searched with the following terms: health professional brain drain from Africa and policies for reducing impact of brain drain from Africa. References were also browsed for relevant articles. A total of 425 articles were available for the study but only 23 articles met the inclusion criteria. The review identified nine policy options, which were being implemented in Africa, but the most common was task shifting which had success in several African countries. This review has demonstrated that there is considerable consensus on task shifting as the most appropriate and sustainable policy option for reducing the impact of health professional brain drain from Africa