MO171BARRIERS TO RENAL SUPPORTIVE CARE IN SINGAPORE: A SURVEY BASED STUDY OF NEPHROLOGISTS, GERIATRICIANS AND PALLIATIVE PHYSICIANS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Yan Ting Chua ◽  
Santhosh Seetharaman ◽  
Priyanka Khatri
Keyword(s):  
Chronic Kidney Disease ◽  
Palliative Care ◽  
Kidney Disease ◽  
Supportive Care ◽  
Community Support ◽  
Public Hospitals ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Asian Countries ◽  
Care Training

Abstract Background and Aims Renal supportive care is a patient-centred approach to management of advanced chronic kidney disease, especially in elderly patients. Adoption of renal supportive care in Asian countries has been slow. This study aims to investigate the barriers towards renal supportive care as perceived by physicians in Singapore. Method An online survey was sent out to all practising and training nephrologists, geriatricians and palliative physicians in Singapore public hospitals between October 1st and October 30th 2020. Responses were compiled and analysed. Results Out of 365 surveys sent, 75 nephrologists, 43 geriatricians and 28 palliative care physicians responded, accounting for a 40% response rate. Most of the participants managed 16 to 30 chronic kidney disease patients in a week. Older patients aged >75 years accounted for at least 30% of the chronic kidney disease cohort managed by 72% of respondents. Most agreed that renal supportive care aims to improve quality of life in chronic kidney disease (97.9%) and can be implemented alongside life-prolonging treatments such as dialysis (83.6%). However, only 51.4% recognised a distinction between renal supportive care and palliative care. Fewer nephrologists compared to geriatricians received prior palliative care training (54.7% vs 93.0%) or were certified advanced care planning facilitators (33.3% vs 67.4%). All respondents agreed that nephrologists should be aware of basic principles of palliative care, and 89.7% felt that palliative care should be incorporated into nephrology training. Most were comfortable holding discussions regarding dialysis withholding and withdrawal (93.8% and 87.7% respectively), and managing symptoms of pain (74.7%), breathlessness (87.0%) and anticipated symptoms after dialysis withdrawal (78.8%). Fewer physicians were comfortable with managing symptoms of pruritus (65.1%) and restless legs syndrome (56.2%). Majority (60%) did not feel confident in providing spiritual support as part of end-of-life care. Main barriers to renal supportive care included inadequate time during clinic consults to address the patients’ needs (87%), reliance on family members to make decisions (69.2%), inadequate palliative training during fellowship (67.1%) and inadequate community support services (55.5%). Some cited lack of awareness and acceptability of renal supportive care amongst patients and relatives in Singapore’s Asian cultural context. Most felt that encouraging advanced care planning discussions earlier in the course of chronic kidney disease (80.8%), having dedicated renal supportive care services in hospital (78.1%) and including palliative care rotation as part of training (69.2%) could potentially increase uptake of renal supportive care in Singapore. Conclusion Nephrologists, geriatricians and palliative physicians in Singapore recognise the value of renal supportive care, but are faced with barriers such as patients’ and family’s resistance toward renal supportive care as well as inadequate palliative training. A unique model of renal supportive care with the patient as well as family’s involvement early in the decision-making process is likely to be better perceived in Asian countries. Incorporation of palliative care training in the nephrology fellowship curriculum should be considered.

Coordination of Care and Care Transitions With Primary Care Clinicians, Specialty Palliative Care, and Hospice

2020 ◽  
pp. 211-219
Author(s):  
Areeba Jawed ◽  
Joseph D. Rotella
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Palliative Care ◽  
Kidney Disease ◽  
Supportive Care ◽  
End Of Life ◽  
Care Coordination ◽  
Care Transitions ◽  
Healthcare Teams ◽  
Primary Care Clinicians

Patients with chronic kidney disease typically have needs that cut across a range of services, including nephrology, other specialties, primary care, and palliative care. This chapter proposes a model of integrated supportive care from diagnosis to end of life that coordinates the efforts and maximizes the benefits of different healthcare teams. Supportive care teams can learn primary kidney supportive care skills to manage symptoms, provide emotional support, and facilitate conversations that focus on what matters most to patients and families. Applying best practices of care coordination, they can facilitate seamless transitions as the patient’s condition evolves.

Primary Palliative Care Education for the Multidisciplinary Nephrology Team

2020 ◽  
pp. 58-66
Author(s):  
J. Pedro Teixeira ◽  
Sara A. Combs
Keyword(s):  
Chronic Kidney Disease ◽  
Palliative Care ◽  
Kidney Disease ◽  
Supportive Care ◽  
Multidisciplinary Team ◽  
Care Program ◽  
Team Members ◽  
Knowledge And Skills ◽  
Palliative Care Education ◽  
End Stage

Supportive care of patients with progressive kidney failure, like the care needed by all patients with chronic kidney disease and end-stage kidney disease, is most successfully provided through a multidisciplinary team. An effective kidney supportive care program requires that the multidisciplinary team be properly educated on the palliative needs of these patients and that team members develop primary palliative care skills to meet these needs. This chapter presents the case for why nephrology clinicians need to acquire primary palliative care knowledge and skills to better treat their patients. It reviews the existing state of supportive care for patients with kidney disease and of the training in primary palliative care currently provided to nephrology fellows and nephrologists. It recommends the development of a primary palliative care curriculum for members of the multidisciplinary kidney care team involved in patient care and makes suggestions on curriculum content for nephrology clinicians.

Models for Operationalizing Supportive Care in Kidney Care

2020 ◽  
pp. 36-46
Author(s):  
Dale E. Lupu ◽  
Emma Murphy
Keyword(s):  
Chronic Kidney Disease ◽  
Palliative Care ◽  
Supportive Care ◽  
Medical Management ◽  
Positive Impact ◽  
Care Planning ◽  
Program Success ◽  
Disease Case ◽  
Advance Care ◽  
The Impact

The field of kidney supportive care is in a period of innovation, with different models emerging from local efforts to improve care. We classify emerging models into six types: embedded, mobile/visiting, chronic kidney disease case management, medical management without dialysis, concurrent hospice/dialysis, and comprehensive regional or system-wide programs. Although individual programs have demonstrated positive impact on outcomes such as advance care planning and place of death, there is not yet systematic evidence comparing the impact of model type on effectiveness or cost effectiveness. Local considerations about need, resources, opportunities, and champions are key to planning a supportive kidney care strategy. Facilitators for program success include training for nephrology providers, active collaboration between nephrology and palliative care, local champions (often nurses), sensitive messaging about medical management without dialysis, and research to demonstrate program impact.

scholarly journals A practical guide to the supportive and palliative care of patients with chronic kidney disease

2020 ◽  
Vol 23 (1) ◽  
Author(s):  
Graham Paget ◽  
Vakhtang Rekhviashvili
Keyword(s):  
South Africa ◽  
Chronic Kidney Disease ◽  
Palliative Care ◽  
Kidney Disease ◽  
Renal Disease ◽  
Supportive Care ◽  
South African ◽  
The South ◽  
The Public ◽  
The World

We are sure that all of us involved in the field of renal medicine in South Africa would agree that the guidelines, published on page 86 of this issue, around the supportive care of renal patients, especially those who cannot access renal replacement therapy – produced in collaboration between the South African Renal Society and the Association of Palliative Care Practitioners of South Africa – will prove valuable in assisting us in making difficult decisions and in providing constructive advice on the management of our patients with advanced chronic kidney disease (CKD).South Africa’s GDP per capita, of around US$3600, places it within the upper-middle-income economic group. Unfortunately, our economy must cope with limited resources with the burden of both non-communicable and communicable diseases. We have one of the highest prevalences of HIV infection in the world, with high frequencies for the APOL1 G1 and G2 risk alleles for HIV-associated (and other) nephropathies [1]. The World Health Organization’s Global Health Observatory (https://www.who.int/data/gho) reports the crude prevalence of hypertension in South Africa at 24%, diabetes at 9.8%, overweight at 51.9% and physical inactivity at 37.2%.The South African Renal Registry [2] reports that 84% of South Africans rely on state-funded medical facilities. A metaanalysis by Kaze et al. [3] quotes the prevalence of CKD stages 3 to 5 to be around 4.8% of the population in sub-Saharan African countries, and in South Africa this amounts to some 2.7 million people with significant kidney disease. Considering our risk profile for renal disease, this is unlikely to be an overestimate. According to the renal registry, only around 11 000 individuals in South Africa are on dialysis or have functioning kidney transplants, with 3100 served by the public sector. Unfortunately, our transplantation rate is low – 4.8 pmp in the public sector and 15.2 pmp in the private sector between 1991 and 2015 [4]. Transplant centres in the UK reported adult deceased donor renal transplant rates between 24 and 66 per million population in 2018/19 [5].We have large numbers of individuals with end-stage renal disease (ESRD), who are on a palliative care path, not by choice, and this is distressing. These guidelines should not be a substitute for ongoing efforts by our government to “move as expeditiously as possible towards the full realisation of the right to healthcare services”, as enshrined in Section 27 of our constitution.We congratulate our nephrology and palliative care community, and thank our visiting Australian colleagues, for well thought out and practical guidelines, which cover all aspects of supportive care for ESRD patients, including effective and caring communication, symptom management, preserving renal function, end-of-life care, care of paediatric patients, and models for setting up a renal palliative care service. The South African Essential Drugs List was used where possible to ensure that the medications are universally available in South Africa. Graham Paget and Vakhtang RekhviashvilliSouth African Renal Society [see PDF file for references]

scholarly journals Predictors of 30-day readmission following hospitalisation with community-acquired pneumonia

2021 ◽  
Vol 8 (1) ◽  
pp. e000883
Author(s):  
Biswajit Chakrabarti ◽  
Steven Lane ◽  
Tom Jenks ◽  
Joanne Higgins ◽  
Elizabeth Kanwar ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Healthcare Professionals ◽  
Metastatic Cancer ◽  
Community Acquired Pneumonia ◽  
Intermediate Care ◽  
Care Planning ◽  
Advanced Care Planning

BackgroundThere is a paucity of UK data to aid healthcare professionals in predicting which patients hospitalised with community-acquired pneumonia (CAP) are at greatest risk of 30-day readmission and to determine which readmissions may occur soonest.MethodsAn analysis of CAP cases admitted to nine UK hospitals participating in the Advancing Quality Pneumonia Programme.ResultsAn analysis was performed of 12 157 subjects hospitalised with CAP in the Advancing Quality Programme Database. 26% of those discharged were readmitted within 30 days with readmission predicted by comorbidity including non-metastatic cancer, diabetes with complications and chronic kidney disease. 41% and 66% of readmissions occurred within 7 and 14 days of discharge, respectively. Patients readmitted within 14 days were more likely to have metastatic cancer (6.6% vs 4.5%; p=0.03) compared with those readmitted at 15–30 days.ConclusionsA quarter of patients hospitalised for CAP are readmitted within 30 days; of those, two-thirds are readmitted within 2 weeks. Further research is required to determine whether such readmissions might be preventable through imple menting measures including in-hospital cross-specialty comorbidity management, convalescence in intermediate care, targeted rehabilitation and advanced care planning.

MO1050ACCESS TO DIALYSIS IN PUBLIC HOSPITALS FOR CHRONIC KIDNEY DISEASE PATIENTS: RESULTS FROM THE HEMODIALYSIS REGISTRY WAITING LIST AT ARISTIDE LE DANTEC HOSPITAL IN SENEGAL

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Moustapha Faye ◽  
Niakhaleen Keita ◽  
Ahmed Tall Lemrabott ◽  
Maria Faye ◽  
Bacary Ba ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Geographic Origin ◽  
Public Hospitals ◽  
Waiting List ◽  
University Hospital ◽  
Social Survey ◽  
Identity Card ◽  
Hospital Director ◽  
Telephone Calls

Abstract Background and Aims The lethality and cost of chronic kidney disease (CKD) management are high in Senegal. The aim of this study was to evaluate the access in dialysis at Senegalese public’s hospitals. Method This was a retrospective cohort during 4 years (2014-2018) from the hemodialysis registry waiting list at Aristide Le Dantec University Hospital. This registry is composed by: a registration form (social survey and doctor's visa); a written letter addressed to hospital director and the national identity card. From this registry, telephone calls were made to collect data relating to mortality and access to dialysis. Results seven hundred fifty-one (751) files were collected. The mean age of the patients was 48.12 ± 15.28 years with a sex ratio of 1.02. The socioeconomic level was low in 85.40% (521/610) and average in 13.61% (83/610). The geographic origin was rural in 11.15%, semi-urban in 07.54% and urban in 81.31%. Ten patients (1.64%) had medical care coverage. On call, 49.70% (373/751) were died before accessing to public dialysis, 29.70% (223/751) had accessed public dialysis and 04.00% (30/751) didn’t yet need dialysis. Hundred twenty-one (16.10%) were unreachable and 0.50% (4/751) was unknown. Conclusion The lethality of CKD was high. Access to dialysis in public hospital remains problematic in Senegal despite its democratization. Additional efforts are needed for effective management of all patients at dialysis stage.

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