To motivate patients on peritoneal dialysis, first motivate staff

Asking patients to perform their own dialysis can be a tall order, even when you provide the needed training. It may take some motivation on the part of the patient—and sometimes on the part of your staff.

(Defining key elements in promoting peritoneal dialysis to patients)

In their poster, “Thriving on PD,” presented at the Annual Dialysis Conference this past week, Mary Jo Miller-Grandfield, RN, BSN, and her dialysis team at Renal Venture Management’s Fort Dodge/Storm Lake, Iowa clinic, set out to spread the word about the value of home dialysis in their mainly rural community. They focused on peritoneal dialysis as the modality choice, saying in the abstract, “There are many misconceptions related to PD therapies and outcomes, both with existing dialysis patients and the medical community.” So the team, with the help of Baxter Health Care, developed a campaign to highlight the positive quality of life improvements for patients going on PD.

The group developed the “We don’t just survive, we thrive,” campaign. That effort include several components, as detailed by Miller-Grandfield:

• “Removal of the word ‘no’ from our vocabulary: all needs, wishes, goals … even prescription changes…are met with an open mind and the patient’s quality of life as a priority.”

• The dialysis team accommodated patient schedules. “…We became very flexible. We arranged our schedule to accommodate the needs of the patients.” The staff trained working patients in the evening and opened early evening lab draws to accommodate work schedules. They became the only program in the area to train nursing home staff on peritoneal dialysis.

• Get patients to talk about the outcomes.  The dialysis team empowered patients “to not only focus on their quality of life but to document that quality via testimonials, pictures and postcards.”

(The benefits of offering extended-hour dialysis shifts)

The results of this positive thinking? After 2.5 years, the Fort Dodge/Storm Lake facility grew their peritoneal dialysis program from five patients to 37, divided between two clinics. “Our goal is to continue to promote PD (and the quality of life benefits) to surrounding physicians and the medical community,” wrote Miller-Grandfield.

http://www.nephrologynews.com/articles/110039-to-motivate-patients-on-peritoneal-dialysis-first-motivate-staff

 

Picture courtesy of www.renalresource.com

 

Medicare proposes coverage for hepatitis C screening

Medicare officials propose to cover screening for hepatitis C virus for adults at high risk of infection as well as a one-time screening for Baby Boomers.

The plan, announced in a coverage memo on March 4, would provide Medicare coverage for all screening tests approved by the Food and Drug Administration when they are ordered by a primary care physician or other primary care clinician.

Officials at the Centers for Medicare & Medicaid Services initially floated the idea of hepatitis C (HCV) screening coverage last September. The response was overwhelmingly positive, with nearly all of the 65 public comments advocating in favor of coverage.

HCV screening is already recommended by the U.S. Preventive Services Task Force and the American Academy of Family Physicians. The AAFP recommends screening for HCV infection in high-risk adults. But the 2013 USPSTF recommendation goes further, calling on physicians to screen high-risk adults as well as to provide a one-time screening to all patients born between 1945 and 1965.

The Medicare proposal echoes the USPSTF recommendations.

For the proposal, the CMS deems the following patients as at high risk for HCV infection: adults who use illicit injection drugs or have a history of such drug use, as well as individuals who had blood transfusions before 1992. The proposal calls for coverage of an initial screening test for high-risk adults, followed by annual rescreening for those who continue to use illicit injection drugs after the first test.

“We acknowledge the limited evidence concerning health outcomes of HCV screening,” agency officials wrote in the coverage memo. “However, CMS believes that screening for HCV infection provides an opportunity for appropriate interventions to benefit the infected person by permitting for the early detection of, and potentially the prevention of, HCV-related liver disease.”

Treatment options for hepatitis C are expanding, the CMS noted in its coverage memo. Over the past several years, the FDA has approved three protease inhibitors, boceprevir (Victrelis), telaprevir (Incivek), and simeprevir (Olysio), for the treatment of patients with genotype 1 infection. Each of these three drugs can be used in combination with pegylated interferon and ribavirin for the treatment of genotype 1 infection.

Last year, the FDA approved sofosbuvir (Sovaldi), which is indicated for the treatment of hepatitis C infection from genotypes 1, 2, 3, or 4. But access to that drug could be impacted by its hefty price tag, which is $1,000 a pill or about $84,000 for a 12-week course of treatment.

Comments on the CMS screening proposal can be made until April 3. The CMS is scheduled to issue a final decision on coverage in June.

mschneider@frontlinemedcom.com

On Twitter @maryellenny

 

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