1. Barriers to Effective Phosphate Control in a Dialysis Population – The Patients Perspective Amanda Waller – Practice/Professional Development Sister Renal Services

2. Aims of Presentation Discuss renal units Research and Practice Development Group Discuss renal units Research and Practice Development Group To highlight Trusts research award To highlight Trusts research award To discuss the research project being carried out To discuss the research project being carried out

3. Background My PDP and development plans for Renal Services My PDP and development plans for Renal Services Multidisciplinary approach Multidisciplinary approach Requirement for improvement in practice Requirement for improvement in practice BTFHT Novice research award BTFHT Novice research award The future The future

4. Background to Research Main research question: ‘What are the barriers preventing some patients from achieving adequate phosphate control’ Main research question: ‘What are the barriers preventing some patients from achieving adequate phosphate control’ Aims of the study: To explore patient perspectives of what prevents them from achieving adequate phosphate control. Aims of the study: To explore patient perspectives of what prevents them from achieving adequate phosphate control. To develop strategies that can be adopted by the health care professionals to support patients in controlling their serum phosphate. To develop strategies that can be adopted by the health care professionals to support patients in controlling their serum phosphate.

5. Patients with end stage renal failure (ESRF) requiring renal replacement therapy either haemodialysis or peritoneal dialysis Compliance with treatment regimes is a continuing challenge for patients Control of serum phosphate is an important component of this treatment High phosphate causes metastatic calcification in joints and myocardium and triggers hyperparathyroidism

6. Removal of phosphate by dialysis is relatively inefficient Requires the patient to restrict their phosphorous intake (milk, dairy products, offal, cola, chocolate) and take phosphate binding medication Past research has shown that dialysis patients are prone to none compliance Reported rates range from 25% to 83%

7. The most frequently used method to promote compliance is the provision of information Studies have shown that educational interventions can have some impact on patients knowledge of phosphate control and their compliance Growing body of research that indicates that medical compliance involves more than educating patients A previous study undertaken within renal unit highlighted this

8. Research Design : Qualitative semi-structured interviews Setting : Haemodialysis (HD) and peritoneal (PD) patients at BFTHT Sample: 20-25 patients receiving regular dialysis with serum phosphate levels of > 1.8mmols/l for 3 consecutive months Measures: A semi structured interview schedule has been devised to identify the patients perceptions of issues that impact on control of phosphate

9. Inclusion Criteria: patients undergoing HD or PD for > 6 months with a serum phosphate level of > 1.8 for 3 consecutive months Who have had an intervention from a dietician for specialist advice about control of phosphate Recruitment: Consent Process:

10. Interview Process: Questions 1)Can you tell me about how meal times are organised in your family/home 2)If there is an event or circumstance that is a change from your normal routine can you discuss how you would make decisions for food choices 3)Can you tell me something about how you organise taking your medications 4)Can you tell me something about your experience of how hcp’s deal with issues around your phosphate levels

11. Ethical Approval: Will be sought from the local LREC Data Analysis: Content analysis will be used to identify themes and categories from the qualitative data. Results:

12. Any Questions?

13. References Ashurst IB, Dobbie H (2003) A randomised control trial of an educational intervention to improve phosphate levels in haemodialysis patients. Journal of Renal Nutrition. 13 (4): 267 – 74 Ashurst IB, Dobbie H (2003) A randomised control trial of an educational intervention to improve phosphate levels in haemodialysis patients. Journal of Renal Nutrition. 13 (4): 267 – 74 Bame SI, Peterson N & Wray N (1993) Variation in haemodialysis compliance according to demographic characteristics. Social Science and Medicine 37 1035-1043 Bame SI, Peterson N & Wray N (1993) Variation in haemodialysis compliance according to demographic characteristics. Social Science and Medicine 37 1035-1043 Deimling A, Denny M, Harrison M, Kerr B, Mayfield M (1984) Effects of an algorithm and patient information on serum phosphorous levels. AANNT Journal 11, 34-38 Deimling A, Denny M, Harrison M, Kerr B, Mayfield M (1984) Effects of an algorithm and patient information on serum phosphorous levels. AANNT Journal 11, 34-38 Ford JC, Pope J, Hunt AE, Gerald B (2004) The effect of diet education on the laboratory values and knowledge of haemodialysis patients with hyperphospatemia. Journal of Renal Nutrition. 14(1): 36 – 34 Ford JC, Pope J, Hunt AE, Gerald B (2004) The effect of diet education on the laboratory values and knowledge of haemodialysis patients with hyperphospatemia. Journal of Renal Nutrition. 14(1): 36 – 34 Katz RC, Ashmore J, Barboa E, Trueblood K, McLaughlin V, Mathews L (1998) Knowledge of disease and dietary compliance in patients with end stage renal disease Katz RC, Ashmore J, Barboa E, Trueblood K, McLaughlin V, Mathews L (1998) Knowledge of disease and dietary compliance in patients with end stage renal disease Psychology Reports 82 (1): 331-6 Psychology Reports 82 (1): 331-6 Korniewicz DM & OBrien ME (1994) Evaluation of a haemodialysis patient education and support program ANNA Journal 21, 33-38 Korniewicz DM & OBrien ME (1994) Evaluation of a haemodialysis patient education and support program ANNA Journal 21, 33-38 Prowant BF, Ryan P, Satalowich RJ (1989) Effectiveness of a phosphorous educational program for dialysis patients. ANNA Journal 16, 353-357 Prowant BF, Ryan P, Satalowich RJ (1989) Effectiveness of a phosphorous educational program for dialysis patients. ANNA Journal 16, 353-357 Renal Association. Treatment of adults and children with renal failure: standards and audit measures. 3rd Edition. London. Royal College of Physicians and the Renal Association 2002 Renal Association. Treatment of adults and children with renal failure: standards and audit measures. 3rd Edition. London. Royal College of Physicians and the Renal Association 2002 Schlatter S, Ferrans CE (1998) Teaching program effects on high phosphorous levels in patients receiving haemodialysis ANNA Journal 25 (1) : 31- 36 Schlatter S, Ferrans CE (1998) Teaching program effects on high phosphorous levels in patients receiving haemodialysis ANNA Journal 25 (1) : 31- 36 Silve C, Friedlander G (2005) Hypo- Hyperphosphataemia Oxford Textbook of Clinical Nephrology 3rd Edition Oxford University Press, Oxford 287 – 308 Silve C, Friedlander G (2005) Hypo- Hyperphosphataemia Oxford Textbook of Clinical Nephrology 3rd Edition Oxford University Press, Oxford 287 – 308 Stoves J, Steel J (2006) Do improvements in patient education lead to an improvement in phosphate control? Unpublished Bradford Hospitals NHS Trust Stoves J, Steel J (2006) Do improvements in patient education lead to an improvement in phosphate control? Unpublished Bradford Hospitals NHS Trust