P0261NARRATIVE NEPHROLOGY: A BIO-PSYCHO-SOCIAL APPROACH WITH CDK PATIENTS

Abstract

Abstract Background and Aims Poor medication adherence in CKD patients can reach up to 80%. Non-adherence is associated with high mortality and morbidity and it is a negative criterion for the inclusion in the transplant waiting list. Poor adherence increases also the costs for health care in terms of diagnostic procedures, dialysis in emergency, etc. Therefore, to increase patients’ adherence to medical treatments is one of the priority of clinical nephrology. According to the WHO adherence behaviors are associated to several factors (e.g. organization of health services, doctor-patient relationship, patients’ psychosocial factors). The most efficacy interventions descried in the literature to increase patients’ adherence to treatments are conducted by a multi-professional team and with the active participation of patients. In the last years, narrative evidenced-based medicine has been proved as a useful methodology in the care of chronic patients also in promoting adherence to treatments. Aim of this clinical project is to obtain the best control of the evolution of chronic kidney disease through a multidisciplinary approach of narrative medicine. Method Within the pre-dialysis service of the Division of Nephrology and Dialysis Firenze 2, it has been integrated the clinical care for CKD patients with a protocol based on a narrative medicine approach (Fig.1). The clinical protocol is composed by the following procedures: Results This project begun around 2 months ago. In this period 15 patients were met, collecting stories by 12 of them (80%). Most of the stories were rich of contents and useful from a medical point of view. None patients refuse the medical consultation at the presence of psychologist, and 5 of them asked for psychotherapy sessions. In line with the literature, 30% of patients presented symptoms of depression. Due to logistic reasons we are going to start the pharmacy counseling intervention at the end of January. All patients were grateful to have been included in this protocol. In the following months we will be able to assess the impact of this protocol in terms of medical outcome. Conclusion To promote an active role of patients in taking care of themselves and follow medical prescriptions, it has been implemented a clinical protocol based on narrative medicine approach in which the biological, psychological and social needs of patients are considered and discussed with them. The empirical results obtained in these first months indicate a positive response from patients in terms of wish to write the experience with the disease and to receive the medical visit with the nephrologist at the presence of a psychologist.