Vallabh (Raj) Shah
In a rural, disadvantaged population, a home-based intervention may improve patients’ activation in their own health and health care and may also decrease risk factors for chronic kidney disease, according to a study published in the Clinical Journal of the American Society of Nephrology.
“The study of home base kidney care funded by the Patient Center Outcomes Research Institute (PCORI) reports that culturally appropriate home-based education delivered by community health representatives can improve patient activation, mental health, and certain CKD risk factors among rural and disparity populations,” Vallabh (Raj) Shah, PhD, MS, FASN, distinguished and regents’ professor of Medicine at the School of Medicine at University of New Mexico HSC, told Healio.com/Nephrology. “Continuous engagement with home-based education may be a promising approach for other adults with CKD who experience barriers to accessing health care. Clinics in rural areas could consider engaging and offering at-home programs with community health representatives to help patients with kidney disease.”
Investigators performed a 12-month clinical trial to assess the efficacy of a home-based kidney care program in 98 rural adult Zuni Indians with CKD. They randomly assigned 50 patients to the intervention group to received home-based care and 48 patients to receive usual care. Individuals who received home-based care also received additional reinforcement by a community health representative about adherence to medicine, diet and exercise, self-monitoring and coping strategies for stress, after the initial lifestyle coaching. A change in patient activation score was the primary outcome. The activation score assessed patients’ knowledge, skill and confidence in the management of their own health and health care.
Results showed after 12 months, the average patient activation score was 8.7 points higher in patients who received intervention compared with those treated with usual care after the adjustment of the baseline score with linear models with generalized estimating equations. Investigators noted patients who received intervention vs. those who received usual care had 4.8 times the odds of having a final activation of at least three. Similarly in both groups, BMI decreased by 1.1 kg/m², HbA1c decreased by 0.7%, high-sensitivity C-reactive protein decreased by 3.3-fold and the SF-12 Health Survey mental score increased by five points. – by Monica Jaramillo
Disclosure s : This research was supported by a PCORI award AD-12-11-5532
and the Intramural Research Program at the National Institute of Diabetes and Digestive and Kidney Diseases.