Development of Service Model Using ECCM to Slowing the Progress of Kidney Disease in Patients with Chronic Kidney Disease Stage 3-4
Keywords:
Chronic Kidney Disease Stage 3-4, Expanded Chronic Care Model (ECCM), Service Model, Slowing Kidney Disease ProgressionAbstract
This research and development study aimed to examine the current situation and develop and evaluate the outcomes of a service model by utilizing the Expanded Chronic Care Model (ECCM) to mitigate the decline of kidney function in patients with stage 3–4 chronic kidney disease (CKD). The sample included 12 healthcare providers and village health volunteers, as well as 40 patients diagnosed with stage 3–4 chronic kidney disease (CKD). The study was carried out between July 2022 and September 2023. The research utilized the ECCM-based service model, semi-structured interviews, and medical records as instruments. The research comprised four distinct phases: situation analysis, model design and development, implementation, and evaluation. We employed content analysis, paired t-tests, and Wilcoxon Signed Rank Tests.
The findings indicated that the current service model was deficient in CKD-specific care, lacked clear guidelines, and did not foster active engagement from families and communities. The updated service model includes eight parts: (1) a policy to prevent kidney problems, (2) programs to promote self-care, (3) a clear system for managing kidney disease, (4) support for making decisions,(5) a connected health information system, (6) public policies that improve health results, (7) creating environments that support kidney health, and (8) initiatives to involve the community. After the new model was put into action, the clinical indicators showed significant improvements at the .05 level, including estimated glomerular filtration rate (eGFR), systolic blood pressure (SBP), LDL cholesterol, and cardiovascular disease (CVD) risk scores. Of the patients, 7.5% progressed to stage 2, 32.5% remained at stage 3a, 20% advanced from stage 3b to 3a, 12.5% stayed at stage 3b, and 10% improved from stage 4 to 3b. This service model is advisable for implementation in primary care environments or as a framework for the management of chronic kidney disease.
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