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Riley, Vess and Dumas’s article, “Home Therapy to Reduce Office Visits for Patients with Chronic Kidney Disease and Anemia” (2017), focuses on implementation of a new referral process for patients in rural areas with barriers to specialty healthcare. With the collaboration of a nurse practitioner (NP) and a nephrologist, a holistic approach was taken in the treatment of patients with both chronic kidney disease (CKD) and anemia. The purpose of this study “was to integrate erythropoiesis-stimulating agents (ESA) therapy with CKD care under one practice setting and to decrease the total number of office visits for CKD and anemia management” (Riley, Vess, & Dumas, 2017).
The author chose this article because of her childhood experience of being raised in a rural area in Nevada and having family members with healthcare issues and limited resources. Access to healthcare is essential for good health and eliminating the barriers to the rural communities. Increased availability would not only improve their quality of life but would also prevent vast progression of chronic disease processes.
The study included a specialist (nephrologist) and an NP working together as a team to provide care to patients in a rural communities via a satellite clinic. The quality improvement (QI) initiative offered patients the opportunity to transition their anemia care to the CKD clinic’s management where they were started on home therapy (Riley et al. 2017). Weekly self-administered injections of ESAs were taught and monitored under the care of an NP. This eliminated the patients need to go to a hematology clinic on a weekly basis for the ESA injection.
No changes were made in the treatment plan of the patients regarding dosage or route of ESA injection and patients were given the opportunity to obtain injections in a clinical setting if they felt uncomfortable with home therapy. Data was collected over a 3-month period and counted the mean number of office visits for anemia and/or CKD each patient had. The information was assembled in an excel spreadsheet and further categorized into Stage 4 and Stage 5 CKD. Pre-implementation aggregate office visits were compared to post-implementation office visits (Riley et al. 2017).
Th goal of this research project was met and reflects in the drastic decrease of the number of office visits made over the 3-month period. By incorporating homecare therapy to treat anemia to this targeted population, office visited “decreased by 56.34% (71 to 31) for patients with CKD Stage 4, and 54.41% (68 to 31) for patients with Stage 5 CKD (Riley et al. 2017). According to the article, “one patient articulated a perception of improved wellness after transitioning from weekly visits to monthly office visits” (Riley et al. 2017). Treating the anemia with the CKD not only improved patient satisfaction but is a critical intervention towards halting or decelerating the progression of CKD (Riley et al. 2017).
The article concluded that by implementing the treatment of anemia into the homecare setting they were able to decrease the amount of office visits and “facilitate practice growth that is holistic, and patient centered” (Riley et al. 2017). Reducing the number of office visits is one way to eliminate the barriers to healthcare in rural communities.
Recommendations include implementing this study in earlier stages of renal failure. Riley et al. (2017) also recommend examining the actual cost savings of homecare to both the patient and the healthcare system. Lastly, although the study empathized patient satisfaction, no actual tracking or scoring was done before and after implementation.
The references for this article all fell within 10 years of the article publication date. Of the 93 articles pulled, only 6 were used due to the other references including patient having, “a medical history of previous renal transplant, patients on dialysis, patients on palliative or hospice care, or anemia not of CKD etiology” (Riley et al. 2017). Two of the references used analyzed the benefits of NPs caring for individuals with CKD, while the remaining focused solely on the treatment of anemia and how it impacts the progression of CKD.
Riley, Vess, and Dumas (2017) clearly state the objective of their research and the purpose behind their study. The introduction of the article gave the author an understanding of the impact anemia has on the progression of CKD. It also caught the authors attention by providing information about how their project positively impacted rural communities that have barriers to specialty healthcare. Riley et al. (2017) did an excellent job in providing the steps they performed during the planning portion that ultimately lead to incorporating an NP in their clinical practice. Although the study states that it was successful in decreasing the number of office visits for the targeted population, the total number of participants involved was never stated, the length of the study was short, and they did not reflect on the patient emotional response to homecare health.
The results performed in this study are consistent with what the author has learned and read in recent text books. In the coordination and management portion of patients with CKD, Ignatavicius text states, “As kidney disease progresses, the patient is seen by a nephrologist or a nephrology nurse practitioner” (Ignatavicius, Workman , & Rebar, 2018) Both texts emphasize the importance of involving the nurse’s unique skill set into caring for patients with CKD. The article confirmed the author’s ideas about the impact nursing care has on providing holistic, patient-centered care and gave a greater understanding of the value of collaborative care.
Telehealth is a developing tool being utilized to obtain the same goal as Riley, Vess and Dumas’s study. The utilization of telehealth is on the rise across the United States and has potential to have a profound impact on patient’s seeking specialist care in rural communities. Burch, Gray and Sharp’s (2017) article, “The Power and Potential of Telehealth: What Health Systems Should Know” discusses the many benefits of telehealth as well as the factors that are preventing its implementation. The article states, “Telehealth enables healthcare professionals to collaborate in providing services across a variety of settings and distances, thereby increasing access, convenience, and engagement for patients” (Burch, Gray, & Sharp, 2017).
In conclusion, the author would recommend this article to her peers because it provides a different perspective of the barriers of access to healthcare. The population served in Nevada consists of many patients that are required to travel to obtain their healthcare needs. Learning about the different ways to overcome these barriers to healthcare for rural populations will strengthen the authors practice by giving her the ability to educate patients about their options.
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