Care Model Development for Slowing the Disease Progression of Patients with Third-Stage Chronic Kidney Disease in San Pa Tong District, Chiang Mai Province

Abstract

This action research aimed to develop a care model to slow the progression of disease in patients with the third-stage chronic kidney disease (CKD) in San Pa Tong District, Chiang Mai Province. From December 2020 to September 2021, the research process consisted of two stages: 1) The first stage involved analyzing the current care situation and developing a care model based on group discussion with 15 patients with third-stage CKD and group meetings with 8 multidisciplinary teams over 3 months. 2) The second stage involved testing and improving the model with 10 third-stage CKD patients over 4 months. The research instruments consisted of: 1) group discussion guidelines, 2) a case management assessment form, 3) consultation guidelines to support self-management, 4) demographic and disease control forms, and 5) an instrument measuring sodium consumption in food. Qualitative data were analyzed by content analysis, while quantitative data were analyzed using frequency, percentage, mean, standard deviation, and Wilcoxon signed-rank test. The results from the care situation analysis revealed that: 1) there was no specific outpatient department for patients with the third-stage CKD, and care outcomes were lower than the standard goal; 2) there was limited access to the services, inadequate health education provision by nurses, and no sufficient surveillance for patients with the third-stage CKD; 3) the food consumption behavior of patients mostly included local foods with high sodium. The care model developed to slow the progression of CKD Patients is comprised of: 1) screening, 2) case management, 3) care provision, 4) support for self-management, 5) monitoring and empowerment, and 6) outcome evaluation. The results from testing the model over 4 months showed that the mean eGFR before and after testing was 47 and 51 ml/min/1.73 m²/yr, respectively, but it was not statistically significant (Z = 1.129, p-value =. 259). However, 33.33% of patients experienced improved CKD stages, and 66.67% remained at the same stage.

The study reflected that the care model to slow the progression of third-stage CKD requires collaboration between the multidisciplinary team and patients, and the involvement of patients in the self-management of reducing sodium shows an advantage in slowing the progression of CKD. Future research should test the model with a comparative group and a larger sample size.