Phosphorus Management Study
In May 2005, The Renal Network, Inc. in participation with Genzyme, began a patient focused plan to improve knowledge and compliance in controlling serum phosphorous. The K/DOQI recommends an Intact PTH level of 150-300pg/ml, a serum phosphorous level of 3.5-5.5mg/dl, and a serum calcium level of 8.4-9.5mg/dl to maintain adequate bone health in the dialysis patient.
Two hemodialysis facilities in Network 9/10 volunteered to pioneer this important project. The education sessions began in May 2005, and ended in September 2005. During this time period patients and staff were instructed in ways to modify patient behaviors and increase self-care. The goal of The Renal Network, Inc., and Genzyme, was to provide a good learning experience for all participants with positive patient outcomes as the result.
Each patient was asked to fill out a questionnaire at the beginning and end of the study period to assess the patients knowledge re: dietary and serum phosphorus. Below are the final results from the pre and post questionnaire.
Pre and Post-test results: RCG Farnsworth, Cleveland, OH
The final patient count for those completing the study cycle, including pre and post-questionnaires is 78. Twenty-seven (27) patients were dropped from the study due to dementia, language barrier, hospitalization, attendance during the study period, and death.
The Patient Questionnaire contains 10 questions. Seven of these questions are objective, requiring factual answers by multiple choice. Those seven are:
- Which of the following contains the most phosphorus?
- What is the best way to control your phosphorus?
- Why do my dietician and doctor want me to take phosphorus binders?
- What is the name of my phosphorus binder medication?
- When should I take my phosphorus binder medication?
- What can happen when phosphorus is high in your blood?
- Which drink is highest in phosphorus?
The following results are based on those seven questions.
- 22.3% of questions were answered incorrectly on the pretest.
- 12.8% of questions were answered incorrectly on the post-test.
This demonstrates a 9.5% improvement in the objective knowledge of participating patients.
The #1 most commonly missed question pre and post-test was #1. Question #8 asks, If you miss taking your phosphate binder what is the usual reason why?
- 57 patients stated they forgot or were not at home.
- 2 Patients complained of nausea or diarrhea
- 2 patients stated they were tired of taking pills
- 2 patients stated cost
- 4 patients stated they ran out
Questions 9 and 10 were patient specific and not assessed for data.
Pre and Post-test results: Blackthorn, South Bend, IN
The final patient count for those completing the study cycle, including pre and post-tests is 84. Forty-two (42) patients were dropped from the study due to dementia, language barrier, hospitalization, attendance during the study period, and death.
The Patient Questionnaire contains 10 questions. Seven of these questions are objective, requiring factual answers by multiple choice.
- Which of the following contains the most phosphorus?
- What is the best way to control your phosphorus?
- Why do my dietician and doctor want me to take phosphorus binders?
- What is the name of my phosphorus binder medication?
- When should I take my phosphorus binder medication?
- What can happen when phosphorus is high in your blood?
- Which drink is highest in phosphorus?
The following results are based on those seven questions.
- 23.9% of questions were answered incorrectly on the pretest.
- 16.4% of questions were answered incorrectly on the post-test.
This demonstrates a 7.5% improvement in the objective knowledge of participating patients.
The #1 most commonly missed question pre and post-test was #1.
Question #8 asked, If you miss taking your phosphate binder what is the usual reason why?
- 60 patients stated they forgot or were not at home.
- 4 patients complained of nausea or choking
- 1 due to missed spin down
- 2 missed mail delivery
This experience demonstrates that consistent patient teaching can result in knowledge that leads to positive changes designed to improve patient outcomes.