European Journal of Nutrition & Food Safety
Permanent URI for this collection
Chief Editor: Prof. Hans Verhagen
ISSN: 2347-5641
Frequency: Quarterly
Language: English
Open Access Peer-reviewed journal
Web site: https://www.sciencedomain.org/journal-home.php?id=30
Browse
Browsing European Journal of Nutrition & Food Safety by Subject "Adherence"
Now showing 1 - 1 of 1
Results Per Page
Sort Options
Item A Clinical Audit and Service Evaluation Exploring Fluid Management and Factors Associated with Non-adherence in Haemodialysis Patients.(2014-07) Kearney, O; Lenderyou, R; Pascoe, S; Wade, B; Collinson, A; Sadler, HBackground : Poor adherence to sodium and fluid restriction is consistently reported worldwide in haemodialysis patients resulting in undesirable clinical outcomes such as hypertension, peripheral oedema, pulmonary oedema and breathlessness [1]. Adherence proves challenging as haemodialysis patients often report high preoccupation with thirst [2]. The aim of this audit was to explore the relationship between fluid management and factors which influence non-adherence and to evaluate the service provided to the haemodialysis patients in a SW Renal Unit. Methods: The audit measured interdialytic weight gain (IDWG) against the European nutritional care of adult renal patients’ standards [3], which use a target of ≤ 2kg IDWG. Mean IDWG over a one week period was used. The audit and service evaluation was conducted on eighty-five participants (65% response rate). Audit data, including mean IDWG, were collected from electronic medical records. The service evaluation was conducted using a piloted questionnaire which addressed four main areas: patient demographics; fluid advice; salt advice and knowledge. Convenience sampling with specific eligibility criteria was employed. Data were analysed using SPSS, version 20. Statistical tests included: Student’s t-test, Pearson’s correlation coefficients and oneway analysis of variance (ANOVA) was used with post hoc analysis with those that showed significance. Ethical approval was granted by Plymouth University and approval gained from the Clinical Audit Department of the Trust. Results: The present study demonstrated that 38% of patients did not meet the audit standard of a target range of ≤ 2kg IDWG. A significant difference was found between males (M=1.96, SD=0.99) and females (M=1.43, SD=0.88); t(83)=2.43, p = 0.017 with 44% of males exceeding the IDWG target range compared to 25% of females. There was a significant positive association between HbA1c in diabetic patients (N = 32; r = 0.364; p = 0.040); knowledge (N = 85; r = 0.329; p = 0.002) and IDWG. A highly significant positive association was found between IDWG and post-dialysis weight (p < 0.001). Younger patients (aged 28 to 63) compared to older patients (aged 75 to 89) were significantly (p = 0.003) more likely to have a higher IDWG. Patients aged 75 to 89 were more likely to meet the audit standard. Although fluid advice was given by dietitians, nurses and consultants, dietitians were significantly more likely to accompany this with advice on salt reduction. Discussion: The results of this study corroborate with the literature to suggest that a certain degree of non-adherence with diet and fluid restrictions is evident in the established renal failure population. Greater knowledge is not associated with better adherence therefore new methods of motivating and engaging patients are required. Behaviour change techniques applied to patients, with particular attention to the younger age group (28 to 63), male patients, and those with poor diabetes control may improve adherence rates. The evidence has shown strategies such as those designed to address health belief factors such as perceived barriers and self-efficacy [4] or using cognitive behavioural therapy (CBT) [5] may facilitate positive behaviour change, however, further research is required in this area. Conclusion: Further studies are required for determining evidence-based treatment goals in this patient population, particularly the younger age group (28 to 63), male and those with poor diabetes control. The service evaluation reveals that dietitians have an important role in promoting both fluid and sodium advice amongst the multidisciplinary team. This advice is an important part of helping patients manages thirst which may influence adherence.