Volume 26, May 2007
Table of Contents
Designing Nephrology Social Work Interventions to Improve Self-Management and Adherence Based on the Dialysis Outcomes and Practice Patterns Study.
Mary Beth Callahan, ACSW/LCSW
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Depression Management for Hemodialysis Patients: Using DOPPS Data to Further Guide Nephrology Social Work Intervention.
Stephanie Johnstone, MSW, LCSW
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DOPPS: Making the Case for Using Functioning and Well-Being Surveys to Assess Risk and Improve Outcomes.
Beth Witten, MSW, ACSW, LSCSW
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Diabetes: The Dialysis Outcomes Practice Patterns Study (DOPPS) Results and Innovative Patient Care Programs.
Wendy Funk Schrag, LMSW, ACSW
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Withdrawal from Dialysis: The Literature, DOPPS, and Implications for Practice.
Karren King, MSW, ACSW, LCSW
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DOPPS and the Elderly: Implications for Nephrology Social Work Practice.
Patricia M. McKevitt, ACSW, LCSW, et al.
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Abstracts From Original Articles
Designing Nephrology Social Work Interventions to Improve Self-Management and Adherence Based on the Dialysis Outcomes and Practice Patterns Study.
Mary Beth Callahan, ACSW/LCSW, Dallas Transplant Institute, Dallas, TX
Along with other studies, the Dialysis Outcomes and Practice Patterns Study demonstrates that adherence to treatment has been shown to impact morbidity and mortality for people with chronic kidney disease. Dialysis treatment teams continue to seek ways to help patients understand the short- and long-term effects of nonadherence to medical recommendations. This article highlights nephrology social work interventions designed to improve patient self-management skills through cognitive behavioral techniques.
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Depression Management for Hemodialysis Patients: Using DOPPS Data to Further Guide Nephrology Social Work Intervention.
Stephanie Johnstone, MSW, LCSW, Fresenius Medical Care-North America, San Diego, CA
The future of disease management for the chronic kidney disease population will need to focus beyond the physiological markers of dialysis adequacy, albumin, and blood pressure and include psychosocial and behavioral health variables that also mediate treatment outcomes. A growing body of literature, including the Dialysis Outcomes and Practice Patterns Study (DOPPS), has linked depression to survival and health care utilization in people on hemodialysis. DOPPS identified the need for improved identification and management of depression. It also provides further guidance for nephrology social workers, who will continue to serve as the lead mental health providers to this at-risk population. This article reviews this literature and proposes practice guidelines for nephrology social workers to help manage depression in the dialysis clinic setting.
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DOPPS: Making the Case for Using Functioning and Well-Being Surveys to Assess Risk and Improve Outcomes.
Beth Witten, MSW, ACSW, LSCSW, Resource & Policy Associate, Medical Education Institute, Inc., Overland Park, KS
The prevention of frailty and dependence optimizes dialysis patients' quality of life and has the potential to reduce the overall costs associated with their care.
(Life Options Rehabilitation Advisory Council, 1994)
Multiple studies of people with chronic kidney disease and kidney failure included measurement of functioning and well-being using the SF-36 or the Kidney Disease Quality of Life™ survey. Those on dialysis have scored consistently lower than norms. The Dialysis Outcomes and Practice Patterns Study found that in patients on hemodialysis low physical component summary and mental component summary scores were significantly associated with higher risks of hospitalization, death, and dialysis withdrawal. Higher scores on the "down in the dumps" and "downhearted and blue" questions were significantly associated with higher risk of hospitalization, death, and dialysis withdrawal. Preliminary research has found that rehabilitation interventions can improve functioning and well-being and that scores can help direct team care planning. More research is needed to determine which clinical social work interventions are associated with improved scores and outcomes. Answering this question could greatly improve the lives of those with kidney disease, save taxpayers' money, and help dialysis centers stay financially viable.
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Diabetes: The Dialysis Outcomes Practice Patterns Study (DOPPS) Results and Innovative Patient Care Programs.
Wendy Funk Schrag, LMSW, ACSW, Fresenius Medical Care North America, Newton, KS
Diabetes is now the leading cause of chronic kidney disease (CKD) in the United States and is also growing in numbers worldwide. The cost of caring for people with diabetes and CKD is escalating and is especially highest from the month prior to starting dialysis to 6 months after beginning dialysis. According to the Dialysis Outcomes Practice Patterns Study (DOPPS), a person with kidney failure who also has diabetes is at higher risk for hospitalization, mortality, retinopathy, blindness and lower limb amputation. The dialysis health care team is challenged to develop new methods of caring for people with diabetes and CKD. Innovative programs reviewed in this article show improved clinical outcomes and an increase in patients' ability to self-manage their disease.
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Withdrawal from Dialysis: The Literature, DOPPS, and Implications for Practice.
Karren King, MSW, ACSW, LCSW, Kansas City, MO
Summary: Withdrawal from dialysis is a common occurrence in the United States, although withdrawal rates vary throughout the world. DOPPS data focusing on withdrawal and the similarities and differences among various countries are reported. Literature related to withdrawal is explored and includes the decision-making process, the reasons underlying the decision, patient characteristics, and the dying experience. Finally, practice suggestions to enhance the delivery of care during the decision-making process and at end of life are offered.
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DOPPS and the Elderly: Implications for Nephrology Social Work Practice.
Patricia M. McKevitt, ACSW, LCSW, Chromalloy American Kidney Center, Washington University, St. Louis, MO; Juergen Bommer, Department of Nephrology, University of Heidelberg, Heidelberg, Germany; Jennifer L. Bragg-Gresham and Ronald L. Pisoni, Arbor Research Collaborative for Health, Ann Arbor, MI; Marcia L. Keen, AMGEN, Inc., Thousand Oaks, CA; Antonio Alberto Lopez, Department of Medicine, Federal University of Bahia, Brazil; Vittorio E. Andreucci, Department of Nephrology, University Federico II of Naples, Naples, Italy; Fumiaki Marumo, Tokyo Medical and Dental University, Tokyo, Japan; Takashi Akiba, Tokyo Women's Medical University, Tokyo, Japan; Tadao Akizawa, Wakayama Medical University, Wakayama, Japan; and Friedrich K. Port, Arbor Research Collaborative for Health, Ann Arbor, MI.
Over the past three and a half decades, since Medicare funding became available for people with end-stage renal disease in the United States, the numbers of elderly on dialysis have increased dramatically and now represent well over half of the dialysis population. Beginning in the late 1970s, psychosocial issues and challenges faced by elderly people on dialysis emerged in the literature. Among other findings, these studies identified increased comorbidities and depressive symptomatology, decreased physical and mental functioning, and improved compliance. These studies were limited in size and represented either single facilities or multiple regional facilities. The Dialysis Outcomes and Practice Patterns Study (DOPPS) is an observational, longitudinal study providing a wide range of data on a sample of people on hemodialysis randomly selected from nationally representative samples of dialysis facilities in 12 countries. In the current investigation, DOPPS findings indicate that the mean age of people on hemodialysis in nearly all study countries is at least 60 years, that cardiac disease is one of the most common comorbidities, that elderly patients are at significantly greater risk for malnutrition, and that compliance with treatment schedules is significantly better in elderly people. Health-Related Quality of Life scores demonstrate that physical functioning is markedly decreased, though mental component summary scores did not decrease with age. Finally, risk of death and withdrawal from dialysis are significantly higher for the elderly. Psychosocial evaluation of the elderly and social work intervention to maximize social, psychological, mental, and physical functioning are addressed, as well as end-of-life issues.
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