Original Investigation
Pathogenesis and Treatment of Kidney Disease
Pilot Study of a Physician-Delivered Education Tool to Increase Patient Knowledge About CKD

https://doi.org/10.1053/j.ajkd.2013.01.023Get rights and content

Background

Limited research exists on physician-delivered education interventions. We examined the feasibility and impact of an educational tool on facilitating physician-patient kidney disease communication.

Study Design

Pilot feasibility clinical trial with a historical control to examine effect size on patient knowledge and structured questions to elicit physician and patient feedback.

Setting & Participants

Adults with chronic kidney disease (CKD) stages 1-5, seen in nephrology clinic.

Intervention

1-page educational worksheet, reviewed by physicians with patients.

Outcomes

Kidney knowledge between patient groups and provider/patient feedback.

Measurements

Patient kidney knowledge was measured using a previously validated questionnaire compared between patients receiving the intervention (April to October 2010) and a historical cohort (April to October 2009). Provider input was obtained using structured interviews. Patient input was obtained through survey questions. Patient characteristics were abstracted from the medical record.

Results

556 patients were included, with 401 patients in the historical cohort and 155 receiving the intervention. Mean age was 57 ± 16 (SD) years, with 53% men, 81% whites, and 78% with CKD stages 3-5. Compared with the historical cohort, patients receiving the intervention had higher adjusted odds of knowing they had CKD (adjusted OR, 2.20; 95% CI, 1.16-4.17; P = 0.02), knowing their kidney function (adjusted OR, 2.25; 95% CI, 1.27-3.97; P = 0.005), and knowing their stage of CKD (adjusted OR, 3.22; 95% CI, 1.49-6.92; P = 0.003). Physicians found the intervention tool easy and feasible to integrate into practice and 98% of patients who received the intervention recommended it for future use.

Limitations

Study design did not randomly assign patients for comparison and enrollment was performed in clinics at one center.

Conclusions

In this pilot study, a physician-delivered education intervention was feasible to use in practice and was associated with higher patient kidney disease knowledge. Further examination of physician-delivered education interventions for increasing patient disease understanding should be tested through randomized trials.

Section snippets

Study Design, Setting, and Participants

Using convenience sampling at one academic center we enrolled patients who were 18 years or older and had established CKD per the National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) definition.9 This diagnosis was determined by medical record review of estimated glomerular filtration rate (eGFR), kidney imaging/related results (eg, biopsy reports), and nephrology provider documentation. Patients had to understand and speak English because our study was not designed

Patient Characteristics

A total of 401 patients were enrolled in the historical cohort, and 155 received the intervention (Fig 3). Among all patients screened within the nephrology clinic, we did not track the number of patients excluded. We previously reported no differences in age and sex comparing patients who enrolled in the historical cohort (responders) versus those who declined to participate (nonresponders).17 In comparing age and sex between responders and nonresponders in the intervention group, we found no

Discussion

In this pilot study, we showed that a brief physician-delivered education intervention is feasible to apply in an outpatient nephrology practice and is associated with increased patient knowledge about CKD. Patients who received the educational intervention had greater awareness and knowledge about kidney disease compared to a historical cohort. Specifically, they were more likely to know they had a kidney problem, recognize their diagnosis of CKD, accurately report its severity, and have a

Acknowledgements

This work was presented in abstract form at the National Kidney Disease Education Program Coordinating Panel Meeting, November 3, 2011, Bethesda, MA, and the American Society of Nephrology's Kidney Week meeting in Philadelphia, PA, November 8-13, 2011.

Support: This work was supported in part by T32 DK007569 and a Clinical Scientist in Nephrology Fellowship Grant from the American Kidney Fund (Dr Wright Nunes). Additional support was provided by the National Institute of Diabetes and Digestive

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    Originally published online March 28, 2013.

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