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Abstract
An increase in the morbidity and mortality associated with chronic kidney disease (CKD) in the state of Maryland necessitates the introduction of a health promotion initiative to address the disease. The primary goal of the initiative is to lower the morbidity of CKD in the state of Maryland. Specific objectives under this goal include educating patients about CKD, conducting regular screening during normal physical exams, and reducing the incidence of end-stage renal disease (ESRD). The secondary goal is to reduce the progression of CKD in patients with the disease. This goal involves objectives such as implementing nutritional interventions, positive lifestyle changes, and medical interventions.
The program will be planned and implemented with the aid of the MAP IT program planning model, which consists of five main stages. George Lakey’s Five Stage Revolutionary Movement Framework will be used to direct the execution of the project. The program leader will collaborate with two main community organizations: National Kidney Foundation Serving Maryland and Delaware and DaVita Kidney Care. The program will be evaluated by comparing baseline data on the prevalence of CKD, screening rates, and the incidence of ESRD with post-intervention data. Patient knowledge levels and adoption of nutritional, lifestyle, and medication changes will be evaluated by comparing pre-intervention and post-intervention questionnaire data. It is expected that the successful implementation of the program will reduce the morbidity associated with CKD and enhance patient outcomes in the disorder.
Program Goal and Objectives
Chronic kidney disease (CKD) leads to the progressive decline of kidney function, which lowers the quality of life of the affected patients and burdens them with high healthcare costs. Therefore, there is a need to implement health promotion programs that educate patients about CKD and ensure timely screening. The primary goal of the project is to reduce the morbidity of CKD in the state of Maryland. To achieve this goal, three main objectives will be met:
- By August 2018, at least 90% of patients in the state of Maryland will receive education about CKD.
- By September 2018, at least 80% of patients in the state of Maryland with the risk factors for CKD will undergo screening for the disease during regular exam visits.
- By August 2019, there will be a 20% reduction in the incidence of end-stage renal disease (ESRD).
The second goal is to reduce the progression of CKD in patients who already have the disease. This goal will include three main interventions namely nutrition, lifestyle, and medical management. The specific objectives are as follows:
- By August 2018, at least 80% of patients with CKD in the state of Maryland will receive nutritional interventions to hold back the advancement of the disorder.
- By January 2019, at least 75% of patients with CKD in the state of Maryland will demonstrate positive lifestyle changes such as 20 minutes of moderate exercise three times a week to reduce the progression of the disease.
- By August 2018, at least 95% of patients with CKD in the state of Maryland will be adherent to their medications to slow down the progress of the condition.
Program Plan
The program will be planned and executed using the MAP IT program planning model. MAP IT consists of five main stages that are described as follows:
Mobilize
The health promotion program will involve the cooperation of various partners, including healthcare institutions in Maryland, the population, as well as state and community programs meant for CKD patients. The vision of the coalition will be to create a healthy community by alleviating the burden of CKD. Patients will be recruited into the program by providing them with informed consent documents.
Assess
Data from the Centers for Disease Control and Prevention (2017) showed that CKD was responsible for the deaths of 11.3 to 14.3% of people in the state of Maryland. Maryland has adequate resources such as healthcare facilities in addition to community and state resources to provide moral and financial support to CKD patients. Therefore, it was necessary to work on the issue of knowledge levels, timely screening, and improving the disease prognosis for patients diagnosed with CKD.
Plan
The initiative will target the reduction of CKD morbidity through patient education and timely screening. The program will also work towards slowing down the progression of CKD. The specific objectives and timelines for the attainment of the objectives have been described in the previous section. The strategies for the implementation of the project are described in the activities and implementation strategy sub-sections of the paper. Patients will be expected to visit health facilities for education sessions and CKD screening. They will also be required to implement the proposed nutritional, lifestyle, and medication recommendations. Conversely, the state and community CKD organizations will be needed to provide eligible patients with appropriate assistance and resources to help them lead healthy lives. Healthcare institutions will implement screening, patient education, provision of dietary, lifestyle, and medical interventions for patients and make referrals to pertinent community and state resources for additional help. The nurse practitioner, who is the program leader, will oversee the implementation and evaluation of the initiative. CKD screening data from patient records in the selected hospitals and online survey responses will be used as indicators of progress.
Implement
Specific healthcare organizations will be selected to act as the coordinating points for the execution of the initiative. These will include five hospitals in the state of Maryland. Members of the community will be made aware of the initiative and its goals through health promotion flyers and public announcements. Details about participation in the program will also be provided through these media.
Track
The program will be tracked by instituting monitoring and evaluation measures in the early phases of the project. For example, baseline data regarding the prevalence of CKD, ESRD, and screening rates will be obtained from medical records. CKD knowledge levels and lifestyle behaviors will be measured by a pre-intervention online survey at the beginning of the program. Online surveys provide fast, reliable, and valid data from populations of interest (McPeake, Bateson, & O’Neill, 2014). However, the major shortcomings of this method may be low response rates and biased answers from the respondents (Rindfuss, Choe, Tsuya, Bumpass, & Tamaki, 2015). Short-term gains will be shared with the community to encourage their participation in the program.
Activities to Achieve Objectives
The main activities that will be undertaken to attain the objectives include educating patients about CKD, its risk factors, progression, and prevention. Screening for CKD during regular exam visits will also be conducted. The major dietary interventions will entail restricting dietary sodium to 2,300 mg/day or less to manage blood pressure. Protein intake will be restricted to approximately 0.8 g per kilogram of body weight per day (Ko, Obi, Tortoricci, & Kalantar-Zadeh, 2017). Phosphorus and potassium levels will also be monitored. Medical interventions will include the proper use of drugs that oppose the renin-angiotensin-aldosterone system such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) as proposed by Xie et al. (2016b). Additionally, diabetic patients will be encouraged to keep their blood sugar levels in check. On the other hand, lifestyle intermediations will include encouraging health-promoting mannerisms such as physical activity and smoking cessation.
Implementation Strategies
Implementation strategies will involve educating all patients about CKD, providing self-management education to patients diagnosed with the disease, and conducting renal function tests for all patients at risk of the disease. A dietitian conversant with CKD eating habits will be engaged to develop customized diets for CKD patients. Patients will be encouraged to do 20 to 30 minutes of aerobic and strength training exercises at least three times a week. Aggravating factors such as hypertension will be controlled by targeting a blood pressure goal of 140/90 mmHg or less (Xie et al., 2016a).
Behavior/Social Change Framework
The social change framework that will direct the program is George Lakey’s Five Stage Revolutionary Movement Framework (Lakey, 2016). This framework presumes that radical change can only take place if a coalition cyclically works through various stages. These stages include cultural preparation, development of organizations, opposition, mass non-cooperation, and the formation of analogous establishments to execute the functions of conventional institutions (Lakey, 2016). Each preceding stage lays the basis for the ensuing phase. This framework also presupposes that the advancement of a movement leads to strong divisions within a group. Therefore, the nurse practitioner will expect some form of resistance against the project, which will be countered by persistence and continued education to stress the importance of the program.
Collaboration with Existing Organizations
The program leader will collaborate with community organizations to reduce the morbidity and mortality of CKD in Maryland. For example, the National Kidney Foundation Serving Maryland and Delaware provide CKD patients with emergency assistance. Patients with ESRD undergoing dialysis are eligible for help from this organization (National Kidney Foundation, 2018). This body offers financial assistance to cater for dental treatment, emergency cost of living, drugs, food, and transport costs of eligible CKD patients. However, this support can only be given to patients following a recommendation from a dietitian or a renal social worker. The nurse practitioner will make appropriate evaluations during the screening of patients and link eligible patients with these professionals for further assistance. DaVita Kidney Care is a community resource that facilitates online support groups for people living with CKD (DaVita Kidney Care, 2018). The nurse practitioner will encourage enrollees of the program to interact with other CKD patients through this resource.
Evaluation
Patient knowledge levels about CKD will be measured by administering program questionnaires to the enrollees before and after the intervention. A comparison of the scores will determine the impact of the intervention on patient knowledge levels concerning CKD. The effectiveness of screening will be determined by checking medical records to find the number of patients who will have undergone CKD screening. Similarly, the screening records will provide information about the proportion of patients with ESRD.
The effectiveness of the intervention on the progression of CKD will be determined by measuring the adoption of positive lifestyle, nutritional, and medication behaviors. These data will be obtained in the form of questionnaires at the end of the study period. The questionnaires would capture data regarding the reception of nutritional advice, engagement in physical exercise, and medication compliance.
Conclusion
Health promotion initiatives enhance patient involvement in their health. However, effective initiatives require proper planning. Therefore, healthcare providers should conduct appropriate research of the communities, their needs, and available resources before implementing health promotion programs.
References
Centers for Disease Control and Prevention. (2017). Kidney disease mortality by state. Web.
DaVita Kidney Care. (2018). Support groups for people living with kidney disease. Web.
Ko, G. J., Obi, Y., Tortoricci, A. R., & Kalantar-Zadeh, K. (2017). Dietary protein intake and chronic kidney disease. Current Opinion in Clinical Nutrition and Metabolic Care, 20(1), 77-85.
Lakey, G. (2016). Toward a living revolution: A five-stage framework for creating radical social change (2nd ed.). Eugene, OR: Wipf and Stock Publishers.
McPeake, J., Bateson, M., & O’Neill, A. (2014). Electronic surveys: How to maximise success. Nurse Researcher, 21(3), 24-26.
National Kidney Foundation. (2018). Patient services and resources. Web.
Rindfuss, R. R., Choe, M. K., Tsuya, N. O., Bumpass, L. L., & Tamaki, E. (2015). Do low survey response rates bias results? Evidence from Japan. Demographic Research, 32, 797-828.
Xie, X., Atkins, E., Lv, J., Bennett, A., Neal, B., Ninomiya, T.,… Chalmers, J. (2016a). Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: Updated systematic review and meta-analysis. The Lancet, 387(10017), 435-443.
Xie, X., Liu, Y., Perkovic, V., Li, X., Ninomiya, T., Hou, W.,… Wang, H. (2016b). Renin-angiotensin system inhibitors and kidney and cardiovascular outcomes in patients with CKD: A Bayesian network meta-analysis of randomized clinical trials. American Journal of Kidney Diseases, 67(5), 728-741.
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