Diabetes Care for Peritoneal Dialysis Clients: Utilizing a Chronic Disease Prevention and Management Approach to Improve Healthcare Outcomes

Abstract

In a Chronic Disease Prevention and Management (CDPM) approach refers to health care services that are collaborative, seamless and supports self-management. A CDPM approach is increasingly a focus of healthcare providers and policymakers in an effort to reduce the burden of chronic disease and to improve client outcomes. Many peritoneal dialysis (PD) clients also have a diagnosis of diabetes. Diabetes management in PD clients is complicated by the glucose load associated with PD; currently there is a paucity of data regarding how diabetes care is provided to PD clients. Utilizing the theory of CDPM, diabetes management in PD Programs (PDP) was examined. Purposeful sampling utilizing a web-based survey collected data from registered dietitians (RD) (N=18) in Ontario with practices in adult PDP. Data was collected on demographic characteristics of PD clients, program models, and program-specific data regarding facilitators and barriers to the provision of dialysis-specific diabetes care. Statistical analysis was completed and responses to open-ended questions examined using thematic open-coding. Results identified three major themes: “walking the CDPM talk” (client focused care); RDs as “unrecognized CDPM champions” (RD as change agents) and “the missing pieces of the CDPM puzzle” (collaboration and integration of care). Conclusions suggest many PDP have embraced CDPM. However, barriers exist which affect the ability of PDP to provide dialysis-specific diabetes care. An opportunity exists to increase the capacity of PDP to provide integrated care via mentorship, professional development opportunities, collaboration with diabetes education programs and team consensus regarding roles and responsibilities related to diabetes management.