Original InvestigationPathogenesis and Treatment of Kidney DiseaseDelivery of Multifactorial Interventions by Nurse and Dietitian Teams in a Community Setting to Prevent Diabetic Complications: A Quality-Improvement Report
Section snippets
Setting
Alberta, a province in Western Canada, has a geographic area the same as Texas, but a population of only 3 million. Two thirds live in 2 major cities (Edmonton and Calgary; Fig 1). The remainder live in rural or semirural settings, mostly distant from major health care facilities.
Canada has a universal, publicly funded, national health care insurance program administered by provincial governments that function as the single insurer. Within Alberta, 9 health regions deliver health care services,
Results
Between March 2004 and December 2005, a total of 570 referrals were received, of which 568 (99%) satisfied entry criteria. A total of 94.5% of referrals were received from family physicians, and the remainder were from specialists. Referrals were received from 189 family physicians, and mean number of patients referred was 3.5 per family physician.
Four hundred sixty-four of these patients had been scheduled for an initial assessment during the data-collection period. Thirty-seven individuals
Discussion
We show that multifactorial interventions can be delivered effectively to patients with diabetes in a community setting using RN/RD teams following algorithms. The proportion of participants using ACE-inhibitor, antiplatelet, and lipid-lowering therapy increased, as did proportions reaching blood pressure, lipid, and glycemic targets. Furthermore, clinically significant improvements in blood pressure, glycemia, lipid levels, and albuminuria were achieved, particularly in subjects not at target
Acknowledgements
Initial funding for the Diabetic Nephropathy Prevention Program was from Alberta Health & Wellness Province Wide Services. Ongoing funding is through the Northern Alberta Renal Program. Capital Health operates the clinics in partnership with East Central Health, Aspen Health, and David Thompson Health Regions. The hard work of our clinical and clerical staff and the cooperation of local primary care physicians is gratefully acknowledged.
Support: Dr Senior and Dr Jindal are supported by the
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Low Mediterranean Diet scores are associated with reduced kidney function and health related quality of life but not other markers of cardiovascular risk in adults with diabetes and chronic kidney disease
2021, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :While we did not explicitly ask patients about how frequently they were following up with this clinic, that fact that diet quality did not improve over time despite likely access to a dietitian, was expected as this has been previously reported [23]. That being said, the success of this program with regards to improvements in glycemic control, blood pressures and lipids through pharmalogical management has been previously documented and likely somewhat explains our cohort's stable cardiometabolic risk factors [46,47]. A strength of this study was the use of repeated 3-day food records enabling serial diet assessments.
Improved Access to and Impact of Registered Dietitian Nutritionist Services Associated with an Integrated Care Model in a High-Risk, Minority Population
2018, Journal of the Academy of Nutrition and DieteticsCitation Excerpt :The traditional PCP schedule does not allow for adequate time or frequency of visits to address these complex diet and lifestyle behavior changes and PCPs admit to not having the expertise or additional training in behavioral change or obesity management necessary to be effective.10,21 Consequently, repeat and frequent appointments are necessary to see significant changes among a high-risk population.1,4,7,12,14,22 Providing increased access to the RDN allows for increased utilization of RDN services in a more time-efficient manner by eliminating wait times for the referral process and by reducing the need to schedule and return to the clinic for separate appointments.
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2017, Clinical NutritionCitation Excerpt :A total of 1390 potential participants from two clinics (Diabetes Nephropathy Prevention Clinic [DNPC] and Renal Insufficiency Clinics [RIC]) in the Northern Alberta Renal Program at Alberta Health Services were screened. The DNPC is a regional program offering specialized interdisciplinary healthcare to patients with DM and CKD; with a focus on co-morbidity risk prevention [21]. The RIC is a regional program offering specialized interdisciplinary healthcare focused on the overall management of patients with CKD (including DM) with the goal of preventing dialysis.
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2013, The LancetCitation Excerpt :Similar considerations apply to the delivery of care to patients with acute kidney injury or with multiple organ failure syndromes (eg, combined hepatic and renal insufficiency; cardiorenal syndrome). Care models that incorporate nurse practitioners are being increasingly used for the management of chronic diseases.51 In view of the success in other fields, the large population at risk for chronic kidney disease, and the low availability of trained nephrologists for the number of patients, it is important to test care models in which physicians partner with nurse practitioners to deliver care.