In dialysis patients providing quality care is a major issue, despite the support provided by healthcare providers they still express dissatisfaction with the quality of care and find it inadequate.
It is very difficult to measure the quality of care because it cannot be scaled or held against a measuring tape and can be able to analyze its composition. There are no direct measures of quality of care. Modification of physical stressors, improved support to dialysis patients, enhancing the quality of dialysis procedure provided by the treatment team, upgrading the facilities and equipment, and adaptation of an interdisciplinary approach are all believed to improve the care services. Still, we must keep in mind that for many dialysis patient’s quality of lives is more important than hospitalization.
Quality care can be provided by identifying the demands, addressing the needs of the patients, obtaining their viewpoints, and prioritizing their problems and preferences.
A dialysis patient expresses dissatisfaction with the quality of care even if there is improved support by healthcare providers. Because of the mental – psychological issues like depression due to variety of factors like financial struggles, unemployment, failure to play their role in family and society, decreased physical activity and cognitive disorders, insufficient family support as family members and friends tend to pay less attention to them over time which may result in the exclusion acts as an influential factor.
The mental – psychological distress is considered as one of the major challenges by healthcare providers. Many researchers indicate that anxiety-induced disorders intensify the chances of suicide, increase morning cortisone levels or 6-interleukin raises the possibility of infection, higher levels of cytokines contribute to malnutrition, development of immune system disorders consequently impact the quality of life in these patients.
There are no direct measures of quality of care, despite there are few studies conducted to evaluate the quality of care with indicators such as clinical performance measures (anemia, adequacy of dialysis, nutritional status, vascular access status and hemodynamic status), comorbid measures (glycemic control, diabetic foot care, cardiovascular protection), socioeconomic factors, environmental and geographic factors, and patient’s lifestyle, etc.
The National Quality Forum endorses Kidney Disease Quality of Life (KDQOL-36) an assessment tool that includes both kidney disease-specific and generic questions which helps to measure psychosocial status at regular intervals.
Quality of life can be wildly measured by utilizing tools like KDQOL-36 and Kidney Disease Quality of Life Short Form questionnaire (KDQOL-SF). Patients achieving serum albumin, adequacy, catheter goals will have higher physical and mental component summary scores in these questionnaires. Patients who do not achieve target hemoglobin and phosphorus levels will be having lower mental and physical component scores.
Patients with a better quality of life scores in KDQOL-36/KDQOL-SF are less ill or more likely to adhere to the treatment regimen and thus more readily achieve target treatment goals. Whereas patients with clinical depression adhere less to treatment regimens and have a lower quality of life scores.
Educational programs for dialysis patients incorporating new techniques such as motivational interviewing may prove to be more successful to achieve quality of life targets.
Engaging patients in collaborative explorations of their behavior patterns using reflective listening, acknowledgment, and exploration may enhance patient’s motivation to implement changes in their patterns and actively participate in the management of their complex medical regimens.
When patients and healthcare teams work together quality of care goals can be easily achieved associated with better survival and better patient’s perceived quality of life. Quality of life plays a very important role in every patient’s life and healthcare providers must understand the needs and requirements of patients which help to improve the care services provided to them.
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