The primary care provider's role in providing supportive and palliative care for patients in chronic renal failure.

René Krause,Nicola Wearne,Tsepo Motsohi,Bianca Davidson

doi:10.4102/safp.v62i1.5238

Abstract

Primary care providers are at the core of providing supportive and palliative care to patients with chronic kidney disease in South Africa. Although dialysis is not always needed, and sometimes not appropriate, for all patients with end-stage kidney disease, there is always supportive and palliative care that can be provided to patients and families to improve outcomes. This article explores the referral pathways, renal preservation, supportive and palliative care and, finally, health system interventions that can improve comprehensive care. The integration of renal supportive and palliative care is a relatively new concept in the paradigm of care and will require advocacy and research to ensure all South African patients have access throughout the trajectory of illness.

Highlights

Primary care providers are at the core of providing supportive and palliative care (PC) to patients with chronic kidney disease (CKD) in South Africa
We are in the initial phases of unpacking the South African needs of end-stage kidney disease (ESKD) patients, it is recommended that supportive care and palliative care for CKD patients should be embedded in the pathways of patients with clear communication between https://www.safpj.co.za healthcare providers from tertiary, secondary and primary care and the same message to patients and families
The care of patients with CKD occurs commonly in primary care and the active integration of supportive and PC must be normalised within the paradigm of care

Summary

Introduction

Primary care providers are at the core of providing supportive and palliative care (PC) to patients with chronic kidney disease (CKD) in South Africa. Dialysis is not always available and sometimes not appropriate for all patients with ESKD in the South African setting.[1] Despite these challenges, the principle of Universal Health Coverage should be followed to ensure promotive, preventive, curative, rehabilitative services and PC for patients with CKD.[2] The primary care clinics are well positioned to deliver supportive and PC to patients on an outpatient basis in line with Primary Health Care principles.[2] community health centres (CHC) have the multidisciplinary resources to buttress PC’s comprehensive team approach.[3] Nephrologists and PC-trained providers are limited by numbers. Communication around the disease, education on the preservation of renal function, reasons why the patient is not for dialysis and advance care planning should be initiated at this point These discussions should preferably include family members and carers using a positive nonjudgemental approach to ensure compassionate and effective communication. We are in the initial phases of unpacking the South African needs of ESKD patients, it is recommended that supportive care and palliative care for CKD patients should be embedded in the pathways of patients with clear communication between https://www.safpj.co.za healthcare providers from tertiary, secondary and primary care and the same message to patients and families

Conclusion

Data availability statement