Barriers to Effective Phosphate Barriers to Effective Phosphate Control in a Dialysis Control in a Dialysis

Population – The Patients Population – The Patients PerspectivePerspective

Amanda Waller – Practice/Professional Amanda Waller – Practice/Professional Development Sister Development Sister

Renal ServicesRenal Services

Aims of PresentationAims of Presentation

Discuss renal units Research and Practice Discuss renal units Research and Practice Development GroupDevelopment Group

To highlight Trusts research awardTo highlight Trusts research award To discuss the research project being carried To discuss the research project being carried

outout

BackgroundBackground

My PDP and development plans for Renal My PDP and development plans for Renal ServicesServices

Multidisciplinary approachMultidisciplinary approach Requirement for improvement in practiceRequirement for improvement in practice BTFHT Novice research awardBTFHT Novice research award The futureThe future

Background to ResearchBackground to Research Main research question: ‘What are the barriers Main research question: ‘What are the barriers

preventing some patients from achieving preventing some patients from achieving adequate phosphate control’adequate phosphate control’

Aims of the study: To explore patient Aims of the study: To explore patient perspectives of what prevents them from perspectives of what prevents them from achieving adequate phosphate control. achieving adequate phosphate control.

To develop strategies that can be adopted by To develop strategies that can be adopted by the health care professionals to support the health care professionals to support patients in controlling their serum phosphate.patients in controlling their serum phosphate.

•Patients with end stage renal failure (ESRF) requiring renal replacement therapy either haemodialysis or peritoneal dialysis

•Compliance with treatment regimes is a continuing challenge for patients

•Control of serum phosphate is an important component of this treatment

•High phosphate causes metastatic calcification in joints and myocardium and triggers hyperparathyroidism

•Removal of phosphate by dialysis is relatively inefficient

•Requires the patient to restrict their phosphorous intake (milk, dairy products, offal, cola, chocolate) and take phosphate binding medication

•Past research has shown that dialysis patients are prone to none compliance

•Reported rates range from 25% to 83%

•The most frequently used method to promote compliance is the provision of information

•Studies have shown that educational interventions can have some impact on patients knowledge of phosphate control and their compliance

•Growing body of research that indicates that medical compliance involves more than educating patients

•A previous study undertaken within renal unit highlighted this

•Research Design : Qualitative semi-structured interviews

•Setting : Haemodialysis (HD) and peritoneal (PD) patients at BFTHT

•Sample: 20-25 patients receiving regular dialysis with serum phosphate levels of > 1.8mmols/l for 3 consecutive months

•Measures: A semi structured interview schedule has been devised to identify the patients perceptions of issues that impact on control of phosphate

•Inclusion Criteria: patients undergoing HD or PD for > 6 months

•with a serum phosphate level of > 1.8 for 3 consecutive months

Who have had an intervention from a dietician for specialist advice about control of phosphate

•Recruitment:

•Consent Process:

• Interview Process:

Questions

1) Can you tell me about how meal times are organised in your family/home

2) If there is an event or circumstance that is a change from your normal routine can you discuss how you would make decisions for food choices

3) Can you tell me something about how you organise taking your medications

4) Can you tell me something about your experience of how hcp’s deal with issues around your phosphate levels

•Ethical Approval: Will be sought from the local LREC

•Data Analysis: Content analysis will be used to identify themes and categories from the qualitative data.

•Results:

Any Questions?Any Questions?

ReferencesReferences

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Deimling A, Denny M, Harrison M, Kerr B, Mayfield M (1984) Effects of an algorithm and patient information on serum Deimling A, Denny M, Harrison M, Kerr B, Mayfield M (1984) Effects of an algorithm and patient information on serum phosphorous levels. AANNT Journal 11, 34-38phosphorous levels. AANNT Journal 11, 34-38

Ford JC, Pope J, Hunt AE, Gerald B (2004) The effect of diet education on the laboratory values and knowledge of Ford JC, Pope J, Hunt AE, Gerald B (2004) The effect of diet education on the laboratory values and knowledge of haemodialysis patients with hyperphospatemia. Journal of Renal Nutrition. 14(1): 36 – 34haemodialysis patients with hyperphospatemia. Journal of Renal Nutrition. 14(1): 36 – 34

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21, 33-3821, 33-38 Prowant BF, Ryan P, Satalowich RJ (1989) Effectiveness of a phosphorous educational program for dialysis patients. ANNA Prowant BF, Ryan P, Satalowich RJ (1989) Effectiveness of a phosphorous educational program for dialysis patients. ANNA

Journal 16, 353-357Journal 16, 353-357 Renal Association. Treatment of adults and children with renal failure: standards and audit measures. 3rd Edition. London. Renal Association. Treatment of adults and children with renal failure: standards and audit measures. 3rd Edition. London.

Royal College of Physicians and the Renal Association 2002Royal College of Physicians and the Renal Association 2002 Schlatter S, Ferrans CE (1998) Teaching program effects on high phosphorous levels in patients receiving haemodialysis Schlatter S, Ferrans CE (1998) Teaching program effects on high phosphorous levels in patients receiving haemodialysis

ANNA Journal 25 (1) : 31- 36ANNA Journal 25 (1) : 31- 36 Silve C , Friedlander G (2005) Hypo- Hyperphosphataemia Oxford Textbook of Clinical Nephrology 3rd Edition Oxford Silve C , Friedlander G (2005) Hypo- Hyperphosphataemia Oxford Textbook of Clinical Nephrology 3rd Edition Oxford

University Press, Oxford 287 – 308University Press, Oxford 287 – 308 Stoves J, Steel J (2006) Do improvements in patient education lead to an improvement in phosphate control? Unpublished Stoves J, Steel J (2006) Do improvements in patient education lead to an improvement in phosphate control? Unpublished

Bradford Hospitals NHS Trust Bradford Hospitals NHS Trust