The Effect of an Educational Patient Compliance Program on Serum Phosphate Levels in Patients Receiving Hemodialysis

Objective: This study sought to determine the effectiveness of a recently developed educational patient compliance program (A Taste for Life [1995]; Abbott Laboratories, Abbott Park, IL) on improving serum phosphate levels in patients receiving hemodialysis.

Design: An ABA time series design was used.

Participants/setting: Eighty-one patients receiving hemodialysis participated. The experimental group consisted of 50 participants (mean [M] = 57.9 years of age; 92% African-American; 62% female) from a private freestanding dialysis unit (Kinston, NC). The control group consisted of 31 control participants (M = 58.2 years of age; 90% African-American; 48% female) from a separate private freestanding dialysis unit (Greenville, NC).

Intervention: The experimental group took part in the educational patient compliance program directed at dietary and medical regimes. The program used educational materials, interactive educational modules, motivational posters, creative games and puzzles, videos, and an in-center achievement contest. The control group did not partake in the program, but received individual ongoing monthly therapy that involved nutrition counseling consistent with the National Renal Diet (American Dietetic Association, 1993) and instruction regarding use of phosphate binders.

Main Outcome Measure: Serum phosphate levels were monitored monthly for 1 year (ie, 3, 3, and 6 months during pretreatment, treatment, and posttreatment, respectively).

Results: No statistically significant differences were found in serum phosphate levels between the two groups (P >.05). There was, however, a significant difference across time within groups. Mean serum phosphate levels significantly declined during the treatment period and further during the posttreatment period relative to the pretreatment baseline (P <.05). Results were not compared with a group of patients receiving hemodialysis who received no nutrition counseling.

Conclusion: The findings suggest that an educational compliance program is equally effective as standard individual ongoing counseling in affecting serum phosphate levels among patients with end-stage renal disease who receive hemodialysis. Results suggest that renal dietitians choose types of intervention within each patient's continuity of care that support individual success.