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Improving Chronic Kidney Disease Care with Group Visits
Title
Improving Chronic Kidney Disease Care with Group Visits.
Creator
Montoya, Vicki, Sole, Mary, Norris, Anne, Wink, Diane, Abbott, Lionel, University of Central Florida
Abstract / Description
First year death rates remain unacceptable high for the end-stage renal disease (ESRD) population. New effective methods are vital to improve first year morbidity and mortality outcomes for the population transitioning from Stage 4 chronic kidney disease (CKD) to ESRD)/Stage 5 CKD. Based on current methods, evidence-based recommendations made by nephrology providers are frequently not heeded by patients in Stage 4 CKD. Low levels of patient knowledge, self-efficacy, and a poor ability to self...
Show moreFirst year death rates remain unacceptable high for the end-stage renal disease (ESRD) population. New effective methods are vital to improve first year morbidity and mortality outcomes for the population transitioning from Stage 4 chronic kidney disease (CKD) to ESRD)/Stage 5 CKD. Based on current methods, evidence-based recommendations made by nephrology providers are frequently not heeded by patients in Stage 4 CKD. Low levels of patient knowledge, self-efficacy, and a poor ability to self-manage CKD negatively influence a patient's ability to follow provider recommendations. The group visit (GV) intervention has demonstrated improvements in disease-related outcomes through increased levels of patient knowledge, self-efficacy, and disease self-management for other chronic diseasses such as diabetes and congestive heart failure (CHF). No data are available for the use of GVs in CKD.The purpose of the study was to develop and test a nurse practitioner-facilitated chronic CKD GV model versus usual nephrology care for Stage 4 CKD patients (knowledge, self-efficacy/self-management, physiological data, and satisfaction). As classified by the National Kidney Foundation's (NKF) staging system, Stage 4 CKD is considered severe kidney disease, with a decrease in the functional capacity of the kidney as determined by a glomerular filtration rate (GFR) of 15-30 ml/min. It is common for patients with Stage 4 CKD to progress to Stage 5 CKD/end-stage renal disease (ESRD), requiring dialysis or transplantation to survive.Preliminary instrumentation and feasibility studies were conducted prior to a pilot study of a CKD GV model. The development and validation of the Stage 4 CKD Knowledge Instrument was completed with 59 Stage 4 patients. Findings supported reliability (Kuder-Richardson-20 [KR] = .89) and content validity (I-CVI = .97, S-CVI= 1.0) Feasibility of the CKD GV model was assessed with a single group, pretest-posttest design using a convenience sample of eight Stage 4 patients. Results demonstrated an improvement in knowledge of CKD from a median of 69% to 86% (p =.012). No improvements were noted in self-efficacy scores (p = .230). GV satisfaction ranged from very good to excellent. Feasibility was supported by a high retention rate (100%). No barriers to participant recruitment or GV implementation were encountered.The pilot study used a two-group, repeated measures experimental design, with a sample of 30 Stage 4 CKD patients from two office locations of an outpatient nephrology practice. Patients were randomized to the GV intervention or to usual nephrology care. CKD-knowledge, self-efficacy, and self-management scores were collected at baseline, six months, and nine months. Physiological data were measured at baseline, six months, and nine months. GV satisfaction was obtained after the completion of GVs (six months). Nephrology practice satisfaction was obtained from by both groups at nine months. MANOVA for repeated measures was calculated for data collected at the three time points.Twenty-six of 30 patients completed the study, with four patients ineligible to complete the study due to progression to ESRD and dialysis initiation. GV attendance was 92%. CKD knowledge was statistically improved for both groups (F(1.498, 34.446) = 6.363, P = .008). While not statistically significant, a favorable upward trend in the mean scores for the subscales of self-management (communication, partnership in care, and self-care) was demonstrated in the GV patients, with a lack of improvement found in the usual care group for these subscales. Self-efficacy scores revealed a non-significant improvement in mean scores for the GV patients during the GVs, not seen with usual care patients. GV satisfaction was again high with the vast majority of patients requesting use of GVs in their future nephrology care. Current methods of intervention in the Stage 4 CKD population have made little impact on reducing first-year ESRD mortality and morbidity rates. Opportunities to intervene in the poor outcomes begin in the predialysis care of Stage 4 patients. Based on the documented success of multidisciplinary approaches in predialysis care, of GVs in other chronic diseases, and of chronic illness care based on the CCM, a high probability for success exists with the application of GVs in CKD. Although limited by a small sample size, promising improvements in the subscales of disease self-management, self-efficacy, CKD knowledge, and high satisfaction with the GV model for GV participants were revealed in this study. Further research is warranted for the CKD GV model on a larger randomized sample in other locations. Much needed data would be provided on which to base decisions for use of the CKD GV intervention in the predialysis care of Stage 4 patients.
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Date Issued
2013
Identifier
CFE0004724, ucf:49827
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0004724
Going to the Doct
Title
Going to the Doct.
Date Created
1900s
Identifier
DP0015458
Format
Set of related objects
PURL
http://purl.flvc.org/ucf/fd/DP0015458
ADOLESCENT MOTHERS IN AN INTERVENTION STUDY: A QUALITATIVE ANALYSIS OF VARIABLES RELATING TO THEIR TEACHING INTERACTIONS WITH THEIR INFANTS
Title
ADOLESCENT MOTHERS IN AN INTERVENTION STUDY: A QUALITATIVE ANALYSIS OF VARIABLES RELATING TO THEIR TEACHING INTERACTIONS WITH THEIR INFANTS.
Creator
Guzman, Janisse, Culp, Anne, University of Central Florida
Abstract / Description
The intent of this thesis was to study, in depth, the experiences of four adolescent mothers who underwent a home intervention program. I studied two mothers who did well with teaching their 12-month old children during play, and two mothers who did not do as well. All four mothers received weekly intervention from the time of their child's birth through 12-months of age. I studied the following variables: 1) how much time the home visitors spent on selected child development and parenting...
Show moreThe intent of this thesis was to study, in depth, the experiences of four adolescent mothers who underwent a home intervention program. I studied two mothers who did well with teaching their 12-month old children during play, and two mothers who did not do as well. All four mothers received weekly intervention from the time of their child's birth through 12-months of age. I studied the following variables: 1) how much time the home visitors spent on selected child development and parenting topics; 2) the mother's perceived social support; 3) how many community resources the mother used; and 4) if the infant was healthy and within normal developmental range. All of the mothers struggled in their lives, yet varied in the quality and time of most of the variables. It was striking how different each one was from the other. The implications of the study are important for child development specialists who can use the qualitative data within this document to better understand first time adolescent mothers in order to improve the outcomes of the home visitation services that they provide to mothers and infants. After spending time studying these four adolescent mothers, I would recommend that adolescent women not get pregnant. Adolescence is a time that is meant for experiences and self-discovery and should be spent free from a dependent child who critically needs them. Future research and funding should be spent on preventing adolescent pregnancy and ensuring that flexible curriculum be utilized by the home visitors in order to meet the varying needs of adolescent mothers.
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Date Issued
2012
Identifier
CFH0004251, ucf:44934
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH0004251
RECIDIVISM PREVENTION THROUGH PROSOCIAL SUPPORT: A SYSTEMATIC REVIEW OF EMPIRICAL LITERATURE
Title
RECIDIVISM PREVENTION THROUGH PROSOCIAL SUPPORT: A SYSTEMATIC REVIEW OF EMPIRICAL LITERATURE.
Creator
McDaniel, Kimber, Lawrence, Shawn, University of Central Florida
Abstract / Description
Of the 700 offenders that are released from prison each year, seven in ten will be rearrested. There are a number of barriers face by released offenders that inhibit their successful reentry. These barriers include: mental health illness, limited work experience, lower education, substance abuse, lack of transportation, homelessness and poverty strain of family ties and/or close relationships. This paper explores the impact of social support on recidivism rates through a systematic review of...
Show moreOf the 700 offenders that are released from prison each year, seven in ten will be rearrested. There are a number of barriers face by released offenders that inhibit their successful reentry. These barriers include: mental health illness, limited work experience, lower education, substance abuse, lack of transportation, homelessness and poverty strain of family ties and/or close relationships. This paper explores the impact of social support on recidivism rates through a systematic review of the literature surrounding prosocial support. The implications for social work practice and research are also discussed.
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Date Issued
2014
Identifier
CFH0004627, ucf:45279
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH0004627