scholarly journals Association of the Comprehensive ESRD Care (CEC) Model with Treatment Adherence

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0006132021
Author(s):  
Richard A. Hirth ◽  
Tammie Nahra ◽  
Jonathan H. Segal ◽  
Joseph Gunden ◽  
Grecia Marrufo ◽  
...  
Keyword(s):  
Treatment Adherence ◽  
Previous Treatment ◽  
Additional Treatment ◽  
Care Organization ◽  
Difference In Differences ◽  
Organization Framework ◽  
Absolute Magnitudes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Matched Comparison

Background: Poor adherence to scheduled dialysis treatments is common and can cause adverse clinical and economic outcomes. In 2015, the Center for Medicare and Medicaid Innovation launched the Comprehensive End-Stage Renal Disease Care (CEC) Model, a novel modification of the Accountable Care Organization framework. Many Model participants reported efforts to increase dialysis adherence and promptly reschedule missed treatments. Methods: With Medicare databases covering 2014-2019, we used difference-in-differences models to compare treatment adherence among patients aligned to 1,037 CEC facilities relative to those aligned to matched comparison facilities, while accounting for their differences at baseline. Using dates of service, we identified patients who typically received three weekly treatments and the days when treatments typically occurred. Skipped treatments were defined as days when the patient was not hospitalized but did not receive an expected treatment, and rescheduled treatments as days when a patient who had skipped their previous treatment received an additional treatment before their next expected treatment date. Results: Patients in the CEC Model had higher odds of attending as-scheduled sessions relative to the comparison group, though the effect was only marginally significant (OR=1.018, p=0.076). Effects were stronger among females (OR=1.028, p=0.062) than males (OR=1.010, p=0.485), and among those under 70 years (OR=1.024, p=0.040) than those 70+ (OR=0.999, p=0.963). The CEC was associated with higher odds of rescheduled sessions (OR=1.092, p<0.001). Effects were significant for both sexes, but were larger among males (OR=1.109, p<0.0001) than females (OR=1.070, p=0.012), and effects were significant among those under 70 years (OR=1.121, p<0.0001), but not those 70+ years (OR=0.990, p=0.796). Conclusions: The CEC Model is intended to incentivize strategies to prevent costly interventions. Because poor dialysis adherence may precipitate hospitalizations or other adverse events, many CEC Model participants encouraged adherence and promptly rescheduled missed treatments as strategic priorities. This study suggests the success of these efforts, though the absolute magnitudes of the effects were modest.

Social support and treatment adherence in patients with end‐stage renal disease: A systematic review

2019 ◽  
Vol 32 (6) ◽  
pp. 562-574 ◽  
Author(s):  
Helena Sousa ◽  
Oscar Ribeiro ◽  
Constança Paúl ◽  
Elísio Costa ◽  
Vasco Miranda ◽  
...  
Keyword(s):  
Social Support ◽  
Systematic Review ◽  
Renal Disease ◽  
Treatment Adherence ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Psychometric Properties and Hidden Dimensionality of the Sinhala Version of End Stage Renal Disease Adherence Questionnaire (SINESRD-AQ) Among Patients Receiving Haemodialysis in a Selected Hospital in Sri Lanka

2021 ◽  
Author(s):  
Chalani Lasanthika ◽  
Kamani Wanigasuriya ◽  
Usha Hettiaratchi ◽  
Thamara Amarasekara ◽  
Sampatha Goonewardena
Keyword(s):  
Sri Lanka ◽  
Renal Disease ◽  
Psychometric Properties ◽  
Treatment Adherence ◽  
End Stage Renal Disease ◽  
Content Validity ◽  
Convergent Validity ◽  
Expert Committee ◽  
Stage Renal Disease ◽  
End Stage

Abstract BackgroundAdherence to a complex therapeutic regimen is crucial to maintain the quality of life of patients receiving haemodialysis. End Stage Renal Disease Adherence Questionnaire (ESRD-AQ) is a valid and most widely used instrument to assess all dimensions of treatment adherence among patients receiving in-center haemodialysis. Though the precise evaluation is fundamental, availability of valid and reliable instruments to evaluate treatment adherence is limited in Sri Lanka. Therefore, the purpose of this study was to evaluate the psychometric properties of Sinhala translated version of ESRD-AQ.MethodsThe translation and cultural adaptation of ESRD-AQ underwent forward and back translation, expert committee consolidation and pretesting among patients (n=10). Face and content validity were evaluated with a panel of experts (n=6) and group of patients (n=10). Confirmatory Factor Analysis (CFA) was performed to evaluate construct validity of two subscales of SINESRD-AQ. Subsequent Categorical Principal Component Analysis (CATPCA) was performed to identify a more parsimonious dimensionality to assess treatment adherence behaviors among patients. Ethical approval was obtained from the Ethics Review Committee, Faculty of Medical Sciences, University of Sri Jayewardenepura and Teaching Hospital, Kurunegala, Sri Lanka. ResultsA total of 150 patients with mean age of 54.08±10.78 (±SD) years were included. Majority were males (72.7%). Excellent face and content validity of SINESRD-AQ was reported. The CFA of two subscales of ESRD-AQ demonstrated barely acceptable model fit (SRMR=0.120, CFI=0.913, GFI=0.997, AGFI=0.996, NNFI=0.896). Subsequent CATPCA revealed new dimensionality with five components explaining 74% of the total variance. Convergent validity of new dimensionality was confirmed with Composite Reliability (CR) and Average Variance Extracted (AVE) with the values greater than 0.7 and 0.5 respectively. According to the Fornell Larcker criterion (1971), the square root of AVEs of components were greater than the inter component correlations and heterotrait-monotrait values were less than the threshold of 0.85 demonstrated the discriminant validity of new dimensionality.ConclusionSINESRD-AQ is a valid and a reliable instrument to assess treatment adherence behaviors among Sinhala speaking patients receiving haemodialysis in Sri Lanka. A follow-up CFA is to be performed to confirm the revised dimensionality of SINESRD-AQ.

scholarly journals Treatment Dynamics in People Who Initiate Metformin or Sulfonylureas for Type 2 Diabetes: A National Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Stephen Wood ◽  
Dianna J. Magliano ◽  
J Simon Bell ◽  
Jonathan E. Shaw ◽  
Jenni Ilomäki
Keyword(s):  
Type 2 Diabetes ◽  
Median Time ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Additional Treatment ◽  
Factors Associated ◽  
National Cohort ◽  
Stage Renal Disease ◽  
End Stage

Aim: To investigate the incidence of, and factors associated with addition and switching of glucose-lowering medications within 12-months of initiating metformin or a sulfonylurea for type 2 diabetes (T2D).Methods: We identified 109,573 individuals aged 18–99 years who initiated metformin or a sulfonylurea between July 2013 and April 2015 using Australian National Diabetes Service Scheme (NDSS) data linked with national dispensing data. Cox proportional hazards regression was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CI) for factors associated with time to addition to or switch from metformin or sulfonylurea over a 12-months follow-up.Results: Treatment addition or switching occurred in 18% and 4% of individuals who initiated metformin and in 28% and 13% of individuals who initiated sulfonylureas. Median time to addition was 104 days for metformin and 82 days for sulfonylureas. Median time to switching was 63 days for metformin and 52 days for sulfonylureas. Congestive heart failure, nicotine dependence, end stage renal disease and dispensing of systemic corticosteroids were associated with higher likelihood of treatment additions and switching in individuals initiating metformin. Antipsychotic dispensing was associated with a higher likelihood of treatment addition in individuals initiating sulfonylureas. Women initiating metformin were less likely to receive treatment additions but more likely to switch treatment than men.Conclusion: Nearly one quarter of Australians who initiate treatment for T2D with metformin or sulfonylureas switch or receive additional treatment within 12-months, with those who initiate sulfonylureas more likely to switch or receive additional treatment than those who initiate metformin.

Sign in / Sign up

Export Citation Format

Share Document