Evaluation of a nurse-led disease management programme for chronic kidney disease: a randomized controlled trial.
BACKGROUND
Patients with end stage renal failure require dialysis and strict adherence to treatment plans to sustain life. However, non-adherence is a common and serious problem among patients with chronic kidney disease. There is a scarcity of studies in examining the effects of disease management programmes on patients with chronic kidney disease.


OBJECTIVE
This paper examines whether the study group receiving the disease management programme have better improvement than the control group, comparing outcomes at baseline (O1), at 7 weeks at the completion of the programme (O2) and at 13 weeks (O3).


METHODS
This is a randomized controlled trial. The outcome measures were non-adherence in diet, fluid, dialysis and medication, quality of life, satisfaction, symptom control, complication control and health service utilisation.


RESULTS
There was no significant difference between the control and study group for the baseline measures, except for sleep. Significant differences (p<0.05) were found between the control and study group at O2 in the outcome measures of diet degree non-adherence, sleep, symptom, staff encouragement, overall health and satisfaction. Sustained effects at O3 were noted in the outcome measures of continuous ambulatory peritoneal dialysis (CAPD) non-adherence degree, sleep, symptom, and effect of kidney disease.


CONCLUSIONS
Many studies exploring chronic disease management have neglected the group with end stage renal failure and this study fills this gap. This study has employed an innovative model of skill mix using specialist and general nurses and demonstrated patient improvement in diet non-adherence, CAPD non-adherence, aspects of quality of life and satisfaction with care. Redesigning chronic disease management programmes helps to optimize the use of different levels of skills and resources to bring about positive outcomes.
Wong
Frances Kam Yuet
FK
School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China. hsfwong@inet.polyu.edu.hk
Chow
Susan Ka Yee
SK
Chan
Tony Moon Fai
TM
D000704:Analysis of Variance; D019090:Case Management; D019468:Disease Management; D005260:Female; D006723:Hong Kong; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000517:prevention & control* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D009720:Nurse Clinicians / Q000193:education / Q000458:organization & administration; D015403:Nursing Evaluation Research; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000451:nursing / Q000523:psychology; D015397:Program Evaluation; D011788:Quality of Life / Q000523:psychology; D012648:Self Care / Q000523:psychology; D016037:Single-Blind Method