Clinical Outcomes of a Home Care Case Management for Patients with Chronic Kidney Disease Stage 3
Keywords:
Chronic Kidney Disease Stage 3, Home Case Management, Clinical Outcomes, Comparative ResearchAbstract
The purposes of this quasi-experimental research were to compare clinical outcomes of a home care case management nursing approach in patients with chronic kidney disease stage 3. Blood pressure, creatinine, urine protein albumin (UPA), albumin-to-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), and hemoglobin A1c (HbA1C) were the compared clinical outcomes in-home case management. Comparisons were between control and experimental groups, and between pre- and post clinical home care case management in patients with chronic kidney disease stage 3. Sample size was 20 patients with chronic kidney disease stage 3, calculated by two independent means, using the N4studies program. Data were collected using personal questionnaires and clinical outcomes. The home care case management process consisted of patients care planning, coordinating, monitoring and evaluation. The home care case management instruments were educational media on kidney disease, a practical guide books for patients with chronic kidney disease, and follow-up phone calls. Frequency, percentage, independent t-test, paired t-test, the mann-whitney u test, and the Wilcoxon signed-rank test were used for data analysis.
Results showed that the mean measures for blood pressure, creatinine, UPA, and ACR were not significantly different between control and experimental groups in post home care case management. There were no significant difference either between pre-and post home case management mean diastolic blood pressure (DBP), BUN, UPA, ACR, and HbA1C.
In contrast, mean eGFR significantly increased, and mean BUN significantly decreased (at P<.05). Mean systolic blood pressure (SBP) and creatinine showed a significant decrease as well, while the mean eGFR was significantly higher at P<.05.
The control of blood pressure and the control of urinary protein leakage in patients with chronic kidney disease should be studied in further research. For more effective outcomes, nurses should coordinate with multidisciplinary home care case management. It would be helpful to use the home care case management as a part of the process of self-care behavior development in patients with chronic kidney disease stage 3.
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