title: Use of dialysis educators beyond nurses and physicians and outcomes in patients with kidney failure.
abstract: This study examined whether patient education by nonmedical personnel (eg, social workers, dietitians) is associated with patient outcomes in a prospective cohort study of 1,005 incident dialysis patients treated at 79 United States clinics. Logistic and Poisson regression and Cox proportional hazards models were used to assess the relationship between clinic use of nonmedical educators and patient satisfaction and self-management, hospitalization, and survival, respectively. Patients treated at clinics reporting use of nonmedical educators (84%) were more likely to be satisfied with the amount of information on dialysis modalities (odds ratio [OR]=.67, 95% confidence interval [CI] 1.08--2.58) and with the amount of information they received on dialysis (OR=1.23, 95% CI 0.90--1.67; marginally significant) than those treated at clinics without nonmedical educators (16%). These patients were also less likely to be hospitalized (incidence rate ratio [IRR]=0.91, 95% CI 0.80--1.03), but the association was of borderline statistical significance. Overall satisfaction, patient self-management, and mortality were not significantly associated with use of nonmedical educators. Use of nonmedical staff for patient education at dialysis centers has a limited but positive effect on patient satisfaction and hospitalization.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Plantinga
authors.forename: Hoangmai H
authors.initials: HH
authors.lastname: Pham
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Fink
authors.forename: Haya R
authors.initials: HR
authors.lastname: Rubin
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D040441:Health Educators; D006282:Health Personnel; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods; D017060:Patient Satisfaction; D011446:Prospective Studies; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000628:therapy*; D014481:United States; D000078329:Workforce