Russo R, Manili L, Tiraboschi G, Amar K, De Luca M, Alberghini E, Ghiringhelli P, De Vecchi A, Porri M T, Marinangeli G, Rocca R, Paris V, Ballerini L
Ospedale Policlinico, Bari, Italy.
Kidney Int Suppl. 2006 Nov(103):S127-32. doi: 10.1038/sj.ki.5001929.
The aim of this multicenter, quantitative, observational study was to analyze compliance and re-training needs of patients on peritoneal dialysis (PD) through the assessment of patient knowledge (with a Patient Questionnaire; phase 1) and patient behavior (home visit with a Score Card; phase 2). A total of 353 patients from 11 Italian centers participated in the first phase and 191 patients from nine centers in the second phase. Overall, 66% of questions on the Patient Questionnaire were answered correctly. Correct answers were more frequent in females than males, in patients under 55 years of age, and in those with higher education. The lowest rate of correct answers involved questions related to diet and physical activity (67% and 51%, respectively). Data collected during the home visit showed that 25% of patients were partially compliant with their drug therapy. Twenty-three percent of patients were non-compliant with the exchange protocol procedures, with a significant association between compliance and the incidence of peritonitis, and 11% were non-compliant with the exit-site protocol procedures without a statistically significant correlation to peritonitis. By combining the two evaluations, we found that approximately one-third (29%) of patients needed reinforcement of knowledge and ability to correctly perform PD as related to infection control and 27% for the correct use of drugs. Looking at the combined evaluation of infection control and drug use, results showed that 47% of patients needed re-training. This need for re-training was greater for younger patients (less than 55 years old), patients with lower education degree and patients in the early or late phase of PD therapy (less than 18 months or more than 36 months). Gender and degree of autonomy had no effect on the need for re-training.
这项多中心、定量、观察性研究的目的是通过评估患者知识（采用患者问卷；第1阶段）和患者行为（使用评分卡进行家访；第2阶段），分析腹膜透析（PD）患者的依从性和再培训需求。来自意大利11个中心的353名患者参与了第一阶段，来自9个中心的191名患者参与了第二阶段。总体而言，患者问卷中66%的问题回答正确。女性、55岁以下患者以及受过高等教育的患者回答正确的频率更高。回答正确率最低的是与饮食和体育活动相关的问题（分别为67%和51%）。家访期间收集的数据显示，25%的患者部分遵守药物治疗。23%的患者不遵守换液操作流程，依从性与腹膜炎发生率之间存在显著关联，11%的患者不遵守出口处操作流程，与腹膜炎无统计学显著相关性。综合两项评估，我们发现约三分之一（29%）的患者在感染控制方面需要强化知识和正确进行腹膜透析的能力，27%的患者在正确用药方面需要强化。从感染控制和药物使用的综合评估来看，结果显示47%的患者需要再培训。年轻患者（小于55岁）、教育程度较低的患者以及腹膜透析治疗早期或晚期（小于18个月或大于36个月）的患者对再培训的需求更大。性别和自主程度对再培训需求没有影响。
