Rasgon S, Schwankovsky L, James-Rogers A, Widrow L, Glick J, Butts E
Division of Nephrology, Southern California Permanente Medical Group, Los Angeles 90027.
Am J Kidney Dis. 1993 Sep;22(3):403-12. doi: 10.1016/s0272-6386(12)70143-9.
An evaluation study was conducted to test the benefit of a predialysis intervention in assisting blue-collar workers with end-stage renal disease (ESRD) to maintain employment. Patients with ESRD were recruited from a large southern California health maintenance organization. In a nonrandomized control trial, employment status among 45 ESRD patients who received a predialysis orientation program followed by in-center dialysis was compared with that of 57 ESRD patients dialyzed at community centers not providing predialysis intervention. Participants had a mean age of 50 years. Sixty-two percent of participants were men and 38% were women. The sample was predominantly Afro-American (35.8%), Hispanic (28.9%), and white (24%). Employment status was assessed prior to dialysis and at least 6 months after beginning maintenance dialysis treatments. The intervention consisted of physician referral to a licensed clinical social worker prior to the initiation of in-center maintenance dialysis treatments, social worker assessment, patient education and counseling, orientation to the dialysis unit, and follow-up care from physicians, licensed clinical social workers, and other team members. A significantly higher proportion of blue-collar workers who received the intervention continued working after beginning dialysis (46.7%) when contrasted with control group blue-collar workers who did not receive the early intervention (23.5%) (chi-squared text = 3.78, P < 0.05). Odds ratio calculations showed that blue-collar workers who received the intervention were 2.8 times more likely to continue working than control group blue-collar workers. The effectiveness of the intervention highlights the importance of early psychosocial intervention in assisting in-center hemodialysis patients in maintaining employment.
开展了一项评估研究，以测试透析前干预措施在帮助患有终末期肾病（ESRD）的蓝领工人维持就业方面的益处。ESRD患者是从南加州一家大型健康维护组织招募的。在一项非随机对照试验中，将45名接受透析前指导计划并随后进行中心内透析的ESRD患者的就业状况，与57名在未提供透析前干预措施的社区中心接受透析的ESRD患者的就业状况进行了比较。参与者的平均年龄为50岁。62%的参与者为男性，38%为女性。样本主要是非洲裔美国人（35.8%）、西班牙裔（28.9%）和白人（24%）。在透析前以及开始维持性透析治疗至少6个月后评估就业状况。干预措施包括在开始中心内维持性透析治疗前由医生转介给持牌临床社会工作者、社会工作者评估、患者教育与咨询、透析单元介绍，以及医生、持牌临床社会工作者和其他团队成员的后续护理。与未接受早期干预的对照组蓝领工人相比，接受干预的蓝领工人在开始透析后继续工作的比例显著更高（46.7%）（卡方检验=3.78，P<0.05）。比值比计算表明，接受干预的蓝领工人继续工作的可能性是对照组蓝领工人的2.8倍。该干预措施的有效性凸显了早期心理社会干预在帮助中心内血液透析患者维持就业方面的重要性。
