Shik, John (2014) The relationship between staffing pattern and process of care in patients with chronic kidney disease (CKD) - an analysis of the data from the CANPREVENT clinical trial. Masters thesis, Memorial University of Newfoundland.
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Chronic Kidney Disease (CKD) is associated with much morbidity and mortality in the general population. It not only is a precursor for End-‐stage renal disease (ESRD), but also serves as a significant risk factor for cardiovascular disease. The care of patients with CKD is complex and often involves blood pressure lowering, renin-‐angiotensin system interruption, lipid lowering, anemia management, and control of mineral metabolism. Currently, the literature lacks evidence and consensus regarding how best to deliver care to this patient population. In particular, the degree of specialist involvement, care consistency, nursing expertise and multidisciplinary team involvement may all influence achievement of treatment targets and ultimately patient outcomes. CANPREVENT was a randomized controlled multicentre trial with 500 subjects comparing usual care by a primary physician to a model of CKD care involving a nurse as a primary caregiver supported by a nephrologist. This model proposes the delivery of a chronic disease management clinic with multiple risk factor intervention for people with moderate chronic kidney disease. By further analyzing data from this trial across the five trial sites, we examined whether differences in nursing educational background, and staffing consistency during the trial, all of which differed by site, were associated with achievement of treatment targets and surrogate outcomes. The hope was that the results would help direct future care and research into care delivery for chronic disease. In this analysis, no major differences in the clinical practice patterns were detected amongst the interventional sites. Overall, none of the interventional sites had consistently superior adherence rates for clinical interventions. However, the small number of sites and the low numbers of eligible participants at each site, reduced the power of the analysis. Based on these results, no clear definite association can be drawn between interventional sites, nursing expertise, continuity of care and practice pattern.
|Item Type:||Thesis (Masters)|
|Additional Information:||Includes bibliographical references (pages 68-75).|
|Department(s):||Medicine, Faculty of|
|Library of Congress Subject Heading:||Chronic renal failure--Patients--Medical care; Chronic renal failure--Treatment; Physician practice patterns|
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