Progetto per uno studio pilota per un ambulatorio di nefrologia narrativa: un approccio bio-psico-sociale alla malattia renale cronica

  • Alessandro Toccafondi SOSD Psicologia Clinica in servizio presso SOC Nefrologia e Dialisi Firenze 2 ASLTC, Firenze - Italia
  • Leonardo Mari Farmacia, Ospedale Borgo San Lorenzo, USL Toscana Centro, Firenze - Italia
  • Umberto Caraccia Coordinatore Ambulatorio di Medicina Narrativa ASL Rieti, Rieti - Italia
  • Silvia Lapini OSD Psicologia Clinica, ASLTC, Firenze - Italia
  • Pietro Dattolo SOC Nefrologia e Dialisi Firenze 2, ASLTC, Firenze - Italia
  • Claudia Capanni Direzione Sanitaria Firenze 2, ASLTC, Firenze - Italia
  • Stefania Polvani Sociologa, Azienda USL Toscana Sud-Est, Presidente Società Italiana di Medicina Narrativa (SIMeN), Arezzo - Italia
  • Marco Lombardi SOS Nefrologia e Dialisi, ASLTC Ospedale del Mugello, Borgo San Lorenzo, Firenze - Italia
Parole chiave: Depression, Narrative medicine, Patient’s compliance, Pre-dialysis, Quality of Life

Abstract

Introduction: Poor medication adherence in CKD patients is associated with high mortality and morbidity and can reach up to 80%. The most effective interventions to increase patients’ adherence to treatments are conducted by a multi-professional team and with the active participation of patients and their families. Narrative evidence-based medicine has been proved as a useful methodology in the care of chronic patients also in promoting their adherence to treatments.

Methods: Around 50-70% of CKD patients treated in our centre will follow clinical protocol based on a narrative medicine approach: (1) patients will be invited to write a brief history related to their experience with the CKD and treatments; (2) screening for depression (HADS; PHQ-9); (3) intervention of pharmaceutical counselling aimed to explore patients’ behaviours about taking their medications; (4) sharing of decision-making: the results of the narrative histories and of questionnaires will be discussed with the patients; (5) psychoeducational groups.

Results: The pilot phase of the project will last 6 months. During these months, patients will be monitored for biochemical (e.g. anemia) and anthropometric (e.g. blood pressure) parameters and depression. Medical visits or diagnostic tests missed by patients will also be recorded.

Conclusions: The development of an active role of patients in taking care of themselves is one of the main challenge of clinical nephrology. The present project aims to implement in the clinical routine a protocol based on the narrative medicine approach in which the biological, psychological and social needs of CKD patients are considered and discussed with them.

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Riferimenti bibliografici

Hill NR, Fatoba ST, Oke JL,, et al. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One. 2016;11(7):e0158765.

De Nicola L, Donfrancesco C, Minutolo R, et al. Epidemiologia della MRC in Italia: stato dell’arte e contributo dello studio CHARES. G Ital Nefrol. 2011;28:(4):401-7.

Rosati A, Francesconi P, Profili F, Mennuti N. Prevalenza e rischi associati di mortalità ed eventi cerebro-cardio-vascolari in Toscana. Toscana Medica. Febbraio 2017.

Ruggenenti P, Perticucci E, Cravedi P, et al. Role of remission clinics in the longitudinal treatment of CKD. J Am Soc Nephrol. 2008;19(6)1213-24.

Turchetti G, Bellelli S, Amato M, et al. The social cost of chronic kidney disease in Italy. Eur J Health Econ. 2017;18(7):847-58.

Kerr M, Bray B, Medcalf J, O’Donoghue DJ, Matthews B. Estimating the financial cost of chronic kidney disease to the NHS in England. Nephrol Dial Transplant. 2012;27Suppl.3:iii73-80.

Durand-Zaleski I, Combe C, Lang P. International Study of Health Care Organization and Financing for end-stage renal disease in France. Int J Health Care Finance Econ. 2007;7(2-3):171-83.

Ministero della Salute. Documento di indirizzo per la malattia renale cronica 2014.

Mechta Nielsen T, Frøjk Juhl M, Feldt-Rasmussen B, Thomsen T. Adherence to medication in patients with chronic kidney disease: a systematic review of qualitative research. Clin Kidney J. 2018;11(4):513-27.

Burnier M, Pruijm M, Wuerzner G, Santschi V. Drug adherence in chronic kidney diseases and dialysis. Nephrol Dial Transplant. 2014;30(1):39-44.

Schmid H, Hartmann B, Schiffl H. Adherence to prescribed oral medication in adult patients undergoing chronic hemodialysis: a critical review of the literature. Eur J Med Res. 2009;14(5):185-90.

Ellis R, Welch J. Medication-taking behaviours in chronic kidney disease with multiple chronic conditions: a meta-ethnographic synthesis of qualitative studies. J Clin Nurs. 2017;26(5-6):586-98.

Mason NA. Polypharmacy and medication-related complications in the chronic kidney disease patient. Curr Opin Nephrol Hypertens. 2011;20:492-7.

Yu YJ, Wu IW, Huang CY, et al. Multidisciplinary predialysis education reduced the inpatient and total medical costs of the first 6 months of dialysis in incident hemodialysis patients. PLoS One. 2014;9(11):e112820.

Cukor D, Rosenthal DS, Jindal RM, Brown CD, Kimmel PL. Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients. Kidney Int. 2009;75(11):1223-9.

Cedillo-Couvert EA, Ricardo AC, Chen J, et al. Self-reported Medication Adherence and CKD Progression. Kidney Int Rep. 2018;3(3):645-51.

Cukor D, Peterson R, Cohen S, et al. Depression in end-stage renal disease hemodialysis patients. Nat Clin Prac Nephr. 2006;12:678-87.

DiMatteo RM, Lepper HL, Croghan TW. Depression is a risk factor for noncompliance with medical treatment. Arch Intern Med. 2000;160:2101-7.

Cukor D, Ver Halen N, Asher DR. Psychosocial intervention improves depression, quality of life, and fluid adherence in hemodialysis. J Am Soc Nephrol. 2014;25:196-206.

De Geest S, Sabaté E. Adherence to long-term therapies: evidence for action. Eur J Cardiovasc Nurs. 2003;2(4):323.

Watzlawick P. Istruzioni per rendersi infelici. Feltrinelli Editore. 1997.

van Vliet LM, Epstein AS. Current state of the art and science of patient-clinician communication in progressive disease: patients’ need to know and need to feel known. J Clin Oncol. 2014;32(31):3474-8.

Pubblicato
2020-04-27
Sezione
Articolo originale

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