title: Using a multidisciplinary training program to reduce peritonitis in peritoneal dialysis patients.
abstract: OBJECTIVE
  The present study evaluated the tool used to assess patients' skills and the impact on peritonitis rates of a new multidisciplinary peritoneal dialysis (PD) education program (PDEP).
  
  
  METHODS
  After the University Hospital Ethics Committee approved the study, the educational and clinical records of PD patients were retrospectively analyzed in two phases. In phase I, an Objective Structured Assessment (OSA) was used during August 2008 to evaluate the practical skills of 25 patients with adequate Kt/V and no mental disabilities who had been on PD for more than 1 month. Test results were correlated with the prior year's peritonitis rate. In phase II, the new PDEP, consisting of individual lessons, a retraining schedule, and group meetings, was introduced starting 1 September 2008. Age, sex, years of education, time on PD, number of training sessions, and peritonitis episodes were recorded. Statistical analyses used t-tests, chi-square tests, and Poisson distributions; a p value of less than 0.05 was considered significant.
  
  
  RESULTS
  In phase I, 25 patients [16 men, 9 women; mean age: 54 ± 15 years (range: 22 - 84 years); mean time on PD: 35 ± 30 months (range: 1 - 107 months)] were studied. The OSA results correlated with peritonitis rates: patients who passed the test had experienced significantly lower peritonitis rates during the prior year (p < 0.05). In phase II, after the new PDEP was introduced, overall peritonitis rates significantly declined (to 0.28 episodes/patient-year from 0.55 episodes/patient-year, p < 0.05); the Staphylococcus peritonitis rate also declined (to 0.09 episodes/patient-year from 0.24 episodes/patient-year, p < 0.05).
  
  
  CONCLUSIONS
  The OSA is a reliable tool for assessing patients' skills, and it correlates with peritonitis rates. The multidisciplinary PDEP significantly improved outcomes by further lowering peritonitis rates.
authors: Centro de Nefrología, Hospital de Clínicas, Universidad de la República, Uruguay. lilianagad@gmail.com
authors: Liliana
authors: L
authors: Gadola
authors: Carla
authors: C
authors: Poggi
authors: María
authors: M
authors: Poggio
authors: Lucía
authors: L
authors: Sáez
authors: Alejandra
authors: A
authors: Ferrari
authors: Jorge
authors: J
authors: Romero
authors: Soledad
authors: S
authors: Fumero
authors: Gianella
authors: G
authors: Ghelfi
authors: Liliana
authors: L
authors: Chifflet
authors: Patricia Larre
authors: PL
authors: Borges
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010353:Patient Education as Topic / Q000379:methods*; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015397:Program Evaluation; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014583:Uruguay / Q000453:epidemiology; D055815:Young Adult