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

Overcoming technical challenges when treating atypical hemolytic uremic syndrome with therapeutic plasma exchange

Edward Zimbudzi Department of Nephrology, Monash Health, Monash Medical Centre, Victoria, Australia Abstract: Atypical hemolytic uremic syndrome (aHUS) is a very rare, life-threatening, progressive disease that frequently has a genetic component and in most cases is triggered by an uncontrolled activation of the complement system. Successful treatment of aHUS with plasma infusions and therapeutic plasma exchange (TPE) is well reported. TPE has been the treatment of choice in most adult patients with aHUS. However, due to severe hemolysis, which is common among aHUS patients, there are some technical challenges that can affect TPE treatment such as the continuous activation of the blood leak alarm due to hemolysis. Our experience shows that such patients can be managed better on a centrifuge based TPE machine compared to a membrane based TPE machine. Keywords: atypical hemolytic uremic syndrome, aHUS, blood leak alarm, centrifuge based TPE, membrane based TPE, therapeutic plasma exchange, TP

How do hospitalization patterns of home hemodialysis patients compare with a reasonably well dialysis patient cohort?

Edward Zimbudzi,1,2 Reggie Samlero1 1Department of Nephrology, Monash Health, Monash Medical Centre, Clayton, Melbourne, VIC, Australia; 2School of Nursing and Midwifery, Faculty of Health Sciences, Latrobe University, Bundoora, VIC, Australia Background: The home hemodialysis (HHD) treatment option has been associated with improved patient outcomes compared to in-center hemodialysis (ICHD) programs. What is not quite clear is the influence of patient selection bias on the perceived benefits of HHD. The purpose of this study was to explore the potential benefits of HHD by comparing the admission patterns of HHD patients with a control group from a reasonably well dialysis patient cohort, which in this case were satellite hemodialysis patients on a Category 1 transplant waiting list (Cat1 SHD). Methods: A single center retrospective randomized cohort study of HHD and Cat1 SHD patients who were on these two treatment modalities from August 2012 to August 2013 was performed to obtain a sample of 25 patients for each group. Results: The mean length of stay in hospital was 5.9 days for HHD patients and 6.7 days for Cat1 SHD group (P=0.8). Eighteen admissions were observed for both groups (0.72 admissions/patient-year; P=0.5). HHD patients spent 71 days and Cat1 SHD patients spent 85 days in hospital (2.8 and 3.4 days/patient-year respectively; P&lt;0.005). The mean serum potassium level for HHD patients was 4.1 (3.1&ndash;6.5) mEq/L versus 5.0 (3.7&ndash;6.1) mEq/L for Cat1 SHD patients (P=0.001) and the mean phosphate level was 1.1 (0.56&ndash;2.38) mg/dL and 1.5 (0.43&ndash;3.2) mg/dL (P=0.02) for the respective groups. Conclusion: This study confirms the superiority of the HHD treatment option in improving patient outcomes. Admission patterns of HHD patients fared very well against a control group which consisted of reasonably well dialysis patients. Keywords: home hemodialysis, satellite hemodialysis, hospitalization patterns, length of sta

Predictors of health-related quality of life in patients with co-morbid diabetes and chronic kidney disease

People living with diabetes and chronic kidney disease (CKD) experience compromised quality of life. Consequently, it is critical to identify and understand factors influencing their health-related quality of life (HRQoL). This study examined factors associated with HRQoL among patients with diabetes and CKD.A cross sectional study among adults with comorbid diabetes and CKD (eGFR <60 mL/min/1.73m2) recruited from renal and diabetes clinics of four large tertiary referral hospitals in Australia was performed. Each participant completed the Kidney Disease Quality of Life (KDQoL ™ -36) questionnaire, which is comprised of two composite measures of physical and mental health and 3 kidney disease specific subscales with possible scores ranging from 0 to 100 with higher values indicating better HRQoL. Demographic and clinical data were also collected. Regression analyses were performed to determine the relationship between HRQoL and potential predictor factors.A total of 308 patients were studied with a mean age of 66.9 (SD = 11.0) years and 70% were males. Mean scores for the physical composite summary, mental composite summary, symptom/problem list, effects of kidney disease and burden of kidney disease scales were 35.2, 47.0, 73.8, 72.5 and 59.8 respectively. Younger age was associated with lower scores in all subscales except for the physical composite summary. Female gender, obese or normal weight rather than overweight, and smoking were all associated with lower scores in one or more subscales. Scores were progressively lower with more advanced stage of CKD (p<0.05) in all subscales except for the mental composite summary.In patients with diabetes and CKD, younger age was associated with lower scores in all HRQoL subscales except the physical composite summary and female gender, obese or normal weight and more advanced stages of CKD were associated with lower scores in one or more subscales. Identifying these factors will inform the timely implementation of interventions to improve the quality of life of these patients.Edward Zimbudzi, Clement Lo, Sanjeeva Ranasinha, Martin Gallagher, Gregory Fulcher ... Helena Teede ... et al

Patient-reported barriers and outcomes associated with poor glycaemic and blood pressure control in co-morbid diabetes and chronic kidney disease

AIMS: In patients with comorbid diabetes and chronic kidney disease, the extent to which patient-reported barriers to health-care and patient reported outcomes influence the quality of health care is not well established. This study explored the association between patient-reported barriers to health-care, patient activation, quality of life and diabetes self-care, with attainment of glycaemic and blood pressure (BP) targets. METHODS: This cross-sectional study recruited adults with diabetes and CKD (eGFR 20 to  0.05). CONCLUSIONS: Specific patient-reported barriers, lack of patient perceived family and primary care physician support, are associated with increased odds of poor glycaemic and blood pressure control respectively. Interventions addressing these barriers may improve treatment target attainment.Clement Lo, Edward Zimbudzi, Helena J.Teede, Peter G.Kerr, Sanjeeva Ranasinha, Alan Cass ... et al

Models of care for co-morbid diabetes and chronic kidney disease

Diabetes and chronic kidney disease (CKD) are two of the most prevalent co-morbid chronic diseases in Australia. The increasing complexity of multi-morbidity, and current gaps in health-care delivery for people with co-morbid diabetes and CKD, emphasize the need for better models of care for this population. Previously, proposed published models of care for co-morbid diabetes and CKD have not been co-designed with stake-holders or formally evaluated. Particular components of health-care shown to be effective in this population are interventions that: are structured, intensive and multifaceted (treating diabetes and multiple cardiovascular risk factors); involve multiple medical disciplines; improve self-management by the patient; and upskill primary health-care. Here we present an integrated patient-centred model of health-care delivery incorporating these components and co-designed with key stake-holders including specialist health professionals, general practitioners and Diabetes and Kidney Health Australia. The development of the model of care was informed by focus groups of patients and health-professionals; and semi-structured interviews of care-givers and health professionals. Other distinctives of this model of care are routine screening for psychological morbidity; patient-support through a phone advice line; and focused primary health-care support in the management of diabetes and CKD. Additionally, the model of care integrates with the patient-centred health-care home currently being rolled out by the Australian Department of Health. This model of care will be evaluated after implementation across two tertiary health services and their primary care catchment areas.Clement Lo, Edward Zimbudzi, Helena Teede, Alan Cass, Greg Fulcher, Martin Gallagher … et al