Narva Andrew S, Norton Jenna M, Boulware L Ebony
Division of Kidney, Urologic, and Hematologic Diseases, National Kidney Disease Education Program, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland; and
Division of Kidney, Urologic, and Hematologic Diseases, National Kidney Disease Education Program, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland; and.
Clin J Am Soc Nephrol. 2016 Apr 7;11(4):694-703. doi: 10.2215/CJN.07680715. Epub 2015 Nov 4.
Patient education is associated with better patient outcomes and supported by international guidelines and organizations, but a range of barriers prevent widespread implementation of comprehensive education for people with progressive kidney disease, especially in the United States. Among United States patients, obstacles to education include the complex nature of kidney disease information, low baseline awareness, limited health literacy and numeracy, limited availability of CKD information, and lack of readiness to learn. For providers, lack of time and clinical confidence combine with competing education priorities and confusion about diagnosing CKD to limit educational efforts. At the system level, lack of provider incentives, limited availability of practical decision support tools, and lack of established interdisciplinary care models inhibit patient education. Despite these barriers, innovative education approaches for people with CKD exist, including self-management support, shared decision making, use of digital media, and engaging families and communities. Education efficiency may be increased by focusing on people with progressive disease, establishing interdisciplinary care management including community health workers, and providing education in group settings. New educational approaches are being developed through research and quality improvement efforts, but challenges to evaluating public awareness and patient education programs inhibit identification of successful strategies for broader implementation. However, growing interest in improving patient-centered outcomes may provide new approaches to effective education of people with CKD.
患者教育与更好的患者治疗效果相关联，并得到国际指南和组织的支持，但一系列障碍阻碍了对进行性肾病患者广泛开展全面教育，尤其是在美国。在美国患者中，教育障碍包括肾病信息的复杂性、基线认知度低、健康素养和算术能力有限、慢性肾脏病（CKD）信息获取有限以及缺乏学习意愿。对于医疗服务提供者而言，时间不足和临床信心不足，再加上教育重点相互竞争以及对CKD诊断存在困惑，限制了教育工作的开展。在系统层面，缺乏对医疗服务提供者的激励措施、实用决策支持工具的可用性有限以及缺乏成熟的跨学科护理模式，都阻碍了患者教育。尽管存在这些障碍，但针对CKD患者的创新教育方法依然存在，包括自我管理支持、共同决策、使用数字媒体以及让家庭和社区参与进来。通过关注进行性疾病患者、建立包括社区卫生工作者在内的跨学科护理管理以及在群体环境中提供教育，教育效率可能会得到提高。正在通过研究和质量改进努力开发新的教育方法，但评估公众认知和患者教育项目的挑战阻碍了识别更广泛实施的成功策略。然而，对改善以患者为中心的治疗效果的兴趣日益浓厚，可能会为有效教育CKD患者提供新方法。
