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MAYWOOD, Ill. -- The constant health education that dialysis patients receive can lead to boredom and noncompliance.

But a Loyola University Medical Center study has found that brief, casual chats can be a significant benefit to patients.

The technique is called "talking control support therapy." As patients were undergoing dialysis, researchers stopped by for informal chats. A typical conversation began with small talk, before moving on to general conversation about healthy dialysis lifestyles. Unlike conventional dialysis education, no specific education goals were set.

After 12 weeks, 82 percent of the study patients met or exceeded their target blood work goals for albumin and phosphorus, compared with 65 percent before the talking control therapy. And there was a 12 percent increase in patient-satisfaction scores.

Results were presented at the National Kidney Foundation 2012 Spring Clinical Meetings.

"In as little as five minutes per week, we can deepen connections to patients in meaningful ways," said Judith Beto, PhD, RD, first author of the study.

The study included 50 of the 120 patients in Loyola's dialysis center. (One patient dropped out after transferring to another unit.) The talking control therapy was conducted by 26 health professionals, including 18 student volunteers.

The health professionals randomly approached patients for informal conversations that lasted five to 10 minutes per week with 31 patients and 20 to 30 minutes per week with 18 patients. A "Getting Better" cart, filled with items as varied as pillboxes, Dots candy and frozen peanut butter-and-jelly sandwiches, was used to initiate conversations. (The health educators explained that the PB&J sandwiches make convenient snacks when patients need to take food with medication, while Dots are an alternative to water for increasing saliva.)

The health educators discussed tips such as: taking medications on time by programming ring reminders on a cell phone, preventing constipation by eating a handful of unsalted almonds and an apple a day and increasing physical activity by wearing a pedometer to record how many steps the patient takes in a day.

Among the patients who underwent the talking control therapy, 24 percent showed stabilization of lab values and 76 percent showed improvement.

Researchers concluded that talking control therapy "may be an effective, low-cost patient-support technique that can involve all members of the interdisciplinary team."

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Published: May 16, 2012

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania.

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WASHINGTON -- A pilot program focused on collaborative care may improve outcomes and reduce costs associated with end-stage renal disease (ESRD), researchers found.

Patients in the Medicare demonstration project met all Quality Incentive Program (QIP) metrics for much of the study, and by the second year of the program had significantly lower costs compared with fee-for-service patients, Allen Nissenson, MD, chief medical officer of DaVita in El Segundo, Calif., and colleagues reported at the National Kidney Foundation meeting here.

The program was implemented in several DaVita dialysis centers in southern California, serving about 550 patients, and was conducted from 2008 to 2010. All patients had aggressive preventive care, management of comorbid conditions, and monitoring by a care manager throughout the entire program.

Nissenson said the program focused on integrating healthcare across various aspects of care, not just the dialysis units, and involved teams comprising clinicians, nurse practitioners, case managers, and pharmacists. In addition to medical management, the program also incorporated nutrition education, fluid management, and other components that made it a more holistic approach to care, he said.

DaVita received a single monthly payment per patient "to cover it all," Nissenson told MedPage Today. "It's sort of like the ultimate bundling."

He and his colleagues evaluated outcomes and costs associated with the demo project. They found that patients hit nine out of 11 QIP targets in the first half of 2008, and then hit all 11 targets after that point through 2010.

The program was able to reduce catheterizations, eliminate drug interactions, and increase vaccination rates, with more than 90% of patients receiving influenza and pneumococcal vaccinations, Nissenson told MedPage Today.

Patients in the program also had fewer hospitalizations than those enrolled in typical Medicare fee-for-service programs, he said.

"The amount of money we can save by avoiding hospitalizations is more than that required to make the initial investment" in implementing the program, he said.

In a cost-effectiveness analysis between the demo costs and the Medicare 5% sample -- a dataset representative of the Medicare fee-for-service population -- the researchers found that costs were lowered with the program, especially after the first year.

Overall medical costs per member per year were 5% lower than fee-for-service programs in 2008, which wasn't significant, but they were a significant 10% lower in 2009 (P<0.01) and an estimated 11% lower in 2010 (2010 Medicare 5% data were unavailable so the researchers adjusted 2009 data to estimate the comparisons).

Inpatient costs with the demo program were a non-significant 7% lower than Medicare 5% data in 2008 and a significant 18% lower in 2009 (P<0.0001), as well as an estimated 18% lower in 2010.

Costs associated with dialysis, however, were slightly but not significantly higher, they reported.

Nissenson said a significant portion of the savings is likely attributable to lower hospitalization costs, and that DaVita is looking to reproduce the project in the context of an Accountable Care Organization (ACO).

Lynda Szczech, MD, president of the NKF, said in a statement that a holistic approach to "caring for kidney patients can lead to better patient outcomes and reduced healthcare costs."

"It's really a win-win situation," she added. "Everyone from the patient on up to the government can benefit from comprehensive disease management care."

The researchers reported no conflicts of interest.

Primary source:National Kidney Foundation
Source reference:
Franco E, et al "Disease management program ESRD patients have lower overall medical costs" NKF 2012.

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Pfizer’s drug candidate for advanced renal cell carcinoma (RCC), Torisel, failed to meet the primary endpoint of progression-free survival in the Phase III Intorsect study. The trial compared Torisel and Nexavar in patients whose disease had progressed on or after treatment with the company’s approved drug Sutent.

Although PFS was numerically higher in patients treated with Torisel, the difference was not statistically significant. The secondary endpoint of overall survival showed statistical significance favoring patients in the Nexavar arm. Nexavar is marketed by Bayer HealthCare and Onyx Pharmaceuticals.

Torisel is already approved in the U.S. and other countries as a treatment of advanced RCC; i.e., not for a specific line of treatment. Today’s news will upset Torisel’s uptake in the second-line setting.

In the EU it is indicated as first-line therapy for advanced RCC patients who have at least three of six prognostic risk factors. In a Phase III study, Pfizer reports, Torisel demonstrated median overall survival (OS) in previously untreated patients with poor prognostic risk of 10.9 months compared with 7.3 months for patients treated with interferon-alpha (IFN-?).

Torisel garnered FDA support in May 2007 for advanced RCC based on a study that showed use of the drug improved OS and PFS. The FDA nod followed the December 2005 sanction of Nexavar, which showed a delay in progression of disease. In January 2006, Pfizer’s Sutent received accelerated approval based on durable response rate, or tumor size reduction, and was later demonstrated to delay tumor progression. Torisel is an intravenously administered mammalian target of rapamycin (mTOR) inhibitor, while Sutent and Nexavar are oral multikinase inhibitors.

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