Advances in research on pre-dialysis patient education in the management of patients with end-stage renal disease
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摘要: 终末期肾脏病(end-stage renal disease,ESRD)的患者人数在全世界呈持续升高趋势,无论是发达国家还是发展中国家都将要面对ESRD所带来的巨大经济负担,迫切需要各地区根据经济发展及资源的不同制定降低疾病负担的有效预防策略。透析前多学科团队合作的患者教育在ESRD中的作用也越来越受到重视,成为ESRD患者管理中的关键环节。患者教育是医患之间沟通的主要桥梁,有助于提高患者相关医学知识,帮助患者提高自我管理疾病能力。进入ESRD期的患者不可避免的要对肾脏替代治疗(renal replacement therapy,RRT)方式做出选择,而患者个人、教育提供者或社会支持系统等多方面原因会影响患者根据自身需要做出合理选择。众多研究表明合理规范的透析前患者教育可以提高患者自我管理能力,增加医学相关知识,延缓疾病进展,避免紧急透析,降低早期死亡率,以及更多地选择腹膜透析作为RRT方案,从而直接或间接地节约社会医疗成本。本综述旨在讨论透析前患者教育对于社会经济和患者个人2个方面的重要意义,影响教育活动进行的因素,患者教育的方式,充分利用移动网络、社区管理平台的便捷对患者进行随访与指导,同时总结其他慢性病管理中的经验,改进患者教育的模式,让患者获得充分的医学知识并主动参与医疗决策,建立以患者为中心的医疗管理模式。Abstract: The number of patients with end-stage renal disease(ESRD) continues to increase all over the world, and both developed and developing countries will face the huge economic burden brought by ESRD. Therefore, it is urgent for us to formulate effective prevention strategies to reduce the disease burden according to different economic development and resources. More and more attention has been paid to the role of multi-disciplinary teamwork in pre-dialysis patient education,which has become a key point in ESRD patient management. Patient education is the main bridge between doctors and patients which can improve patients' medical knowledge and the ability of disease self-management. Patients entering ESRD stage inevitably need to choose the method of RRT(Renal Replacement Therapy), while the difference of patients' personal situation, education provider or social support system will influence them to make reasonable choices according to their own needs. Previous studies have shown that rational and standardized pre-dialysis patient education can improve patients' self-management ability and increase their medical-related knowledge, and these efforts will delay disease progression, avoid emergency dialysis and reduce early mortality. If patients choose more peritoneal dialysis as RRT program, it will directly or indirectly save social medical costs. This review aims to discuss the effects and significance of pre-dialysis patient education on the social economy and patient's personal health. We also discuss the factors that influence patient education, and we expect to make full use of the mobile network and community management platform for the patient follow-up and guidance. At the end, we will summarize the experiences of other chronic diseases management, gradually improve the model of patient education which enabling patients to obtain sufficient medical knowledge and participate in medical decisions actively, and will establish a patient-centered medical management model in the future.
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Key words:
- Pre-dialysis education /
- Chronic kidney disease /
- Peritoneal dialysis /
- Hemodialysis
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