120 Adopting Patient-Centered Care in Managing Chronic Kidney Disease

2020 ◽  
Vol 75 (4) ◽  
pp. 570
10.2196/10173 ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. e10173 ◽  
Author(s):  
Ying-Li Lee ◽  
Yan-Yan Cui ◽  
Ming-Hsiang Tu ◽  
Yu-Chi Chen ◽  
Polun Chang

Author(s):  
Kelly Li ◽  
Mark Brown

This chapter outlines the management of patients with advanced chronic kidney disease for whom dialysis may not be beneficial or desired. Active medical management without dialysis should be offered to patients through a shared-decision making process as a viable alternative to dialysis. This is important as patients and families wish to consider not only survival, but also symptom control and QoL in their decision to pursue a dialysis or nondialysis pathway. A multidisciplinary team delivering good quality, active, and patient-centered care that combines chronic kidney disease management with the principles of palliative care can help patients achieve good symptom management and quality of life. Active and early planning for the end-of-life phase facilitates appropriate care for patients in acute and/or unexpected deterioration and helps achieve patient and family goals.


2018 ◽  
Author(s):  
Ying-Li Lee ◽  
Yan-Yan Cui ◽  
Ming-Hsiang Tu ◽  
Yu-Chi Chen ◽  
Polun Chang

BACKGROUND Chronic kidney disease (CKD) is a global health problem with a high economic burden, which is particularly prevalent in Taiwan. Mobile health apps have been widely used to maintain continuity of patient care for various chronic diseases. To slow the progression of CKD, continuity of care is vital for patients’ self-management and cooperation with health care professionals. However, the literature provides a limited understanding of the use of mobile health apps to maintain continuity of patient-centered care for CKD. OBJECTIVE This study identified apps related to the continuity of patient-centered care for CKD on the App Store, Google Play, and 360 Mobile Assistant, and explored the information and frequency of changes in these apps available to the public on different platforms. App functionalities, like patient self-management and patient management support for health care professionals, were also examined. METHODS We used the CKD-related keywords “kidney,” “renal,” “nephro,” “chronic kidney disease,” “CKD,” and “kidney disease” in traditional Chinese, simplified Chinese, and English to search 3 app platforms: App Store, Google Play, and 360 Mobile Assistant. A total of 2 reviewers reached consensus on coding guidelines and coded the contents and functionalities of the apps through content analysis. After coding, Microsoft Office Excel 2016 was used to calculate Cohen kappa coefficients and analyze the contents and functionalities of the apps. RESULTS A total of 177 apps related to patient-centered care for CKD in any language were included. On the basis of their functionality and content, 67 apps were recommended for patients. Among them, the most common functionalities were CKD information and CKD self-management (38/67, 57%), e-consultation (17/67, 25%), CKD nutrition education (16/67, 24%), and estimated glomerular filtration rate (eGFR) calculators (13/67, 19%). In addition, 67 apps were recommended for health care professionals. The most common functionalities of these apps were comprehensive clinical calculators (including eGFR; 30/67; 45%), CKD medical professional information (16/67, 24%), stand-alone eGFR calculators (14/67, 21%), and CKD clinical decision support (14/67, 21%). A total of 43 apps with single- or multiple-indicator calculators were found to be suitable for health care professionals and patients. The aspects of patient care apps intended to support self-management of CKD patients were encouraging patients to actively participate in health care (92/110, 83.6%), recognizing and effectively responding to symptoms (56/110, 50.9%), and disease-specific knowledge (53/110, 48.2%). Only 13 apps contained consulting management functions, patient management functions or teleconsultation functions designed to support health care professionals in CKD patient management. CONCLUSIONS This study revealed that the continuity of patient-centered care for CKD provided by mobile health apps is inadequate for both CKD self-management by patients and patient care support for health care professionals. More comprehensive solutions are required to enhance the continuity of patient-centered care for CKD.


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