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Proximity therapeutic education for patients with chronic kidney disease: a new strategy for better management

Author: 
Eliane Mikkelsen Ranivoharisoa, Philippes Chauveau, Veronique François, Christine Nazaris, Jean Arnautou and Pierre Merville
Subject Area: 
Health Sciences
Abstract: 

The chronic kidney disease is a public health problem in aggravation. The management requires best conditions for dialysis initiation. The national and international recommendations suggest multidisciplinary management of chronic disease. We report here the experience of "Lot-et-Garonne" regarding the benefits of a proximity nurses and dietitians counseling. Since its five years of existence, we would evaluate the impacts of the proximity therapeutic education offered by theses paramedical teams in the management of patients with chronic kidney disease. The main objective is to determine if the Proximity Nurse and Dietitian Counseling could reduce the emergency dialysis. We have selected 212 patients new dialyzed, divided into 3 groups according to the types of consultations which they have benefited. The main objective is to determine if the Proximity Nurse and Dietitian Counseling could decrease the emergency dialysis. The others objectifs are to determine if it could increase the using of native fistula for starting the dialysis, secondly if it could increase the rate of dialysis in satellites dialysis center and finally if it could increase the survival rate one year after starting the dialysis. During this study, patients were divided into 3 groups according to the types of consultations which they have benefited. So, 93 patients were followed exclusively by nephrologists, 76 have had a medical nephrology monitoring and hospital nurse consultation and 43 have benefited the Proximity Nurse and Dietitian Counseling in ad of both previous consultations. The proximity Nurse and Dietitian Counseling allowed to decrease significantly the emergency dialysis in 43% to 20.28%. It could increased significantly also the using of artery veinous fistula passing 44.09% in Groupe 1 to 90,7% in Groupe 3 and the transfert in Satellites Auto-Dialysis Unit or Antennas passing 39.78% to 74.42% in the two previous groupes without changing the survival rate. The presence of the paramedical management including nurse and dietitian counseling are close substitutes consultations. Sometimes, they induce medical consultations required for strict monitoring of patients. Its benefits is not only reducing the emergency dialysis but also promoting the using of artery veinous fistula and the hemodialysis in antennas and so producing different economic impacts at all levels. The proximity educational therapeutic helped for managing the patients with chronic kidney disease. It should be included in their care management.

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