Patient adherence to Continuous Ambulatory Peritoneal Dialysis treatment in a low-resource setting: An interventional study

Abstract

Background: Continuous Ambulatory Peritoneal Dialysis (CAPD) is an affordable home-based treatment method for low-resource settings. Currently, CAPD facilities in low-resource settings are expanding in Sri Lanka. Non-adherence of patients and caregivers to the treatment is a major problem.Objective: To assess the current adherence and outcome of CAPD in low-resource settings, design an intervention to reduce the current shortcomings and evaluate the results of the intervention for improving patient adherence.Methods: This was an interventional research project with patients undergoing CAPD. Interviewer-administered questionnaires and key informant interviews during the pre and post-intervention stages were used to assess adherence. Gaps identified after analysing the results of pre-intervention were used to design the intervention. Three “one-day” workshops were conducted to improve adherence. The new system was introduced and continued for five months, after which post-intervention was assessed. McNemar’s and paired t-tests were used to measure the statistical significance.Results: Most of the participants were males, aged 50 to 59 years. Results showed that intervention proved to be effective in improving overall feelings about current health conditions (p=0.004). The number of days a patient stayed in a hospital decreased after the intervention (p=0.001). It showed a positive effect on overall personal hygiene practices (p=0.000). Further, intervention positively impacted record keeping (p=0.096).Conclusion: The intervention significantly contributed to improving patient adherence and caregivers' knowledge. Continuous assessment, training programs, and home visits for problematic patients should be implemented to improve adherence and sustainability of the CAPD.