I’d like to write another book" – Integrated Primary Care for an At-Risk Elder (IPCARE) Requiring Expedited Peritoneal Dialysis from Rapid Progression of End-Stage Renal Failure

The Singapore family physician Pub Date : 2021-10-01 DOI:10.33591/sfp.47.8.up1

Gabrielle N. Yee

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Abstract

An 84-year-old gentleman with stage 5 chronic kidney disease (CKD) from diabetic nephropathy required community hospital step-down after repeated hospitalisations for fluid overload. Renal function decline outpaced appointments for initiation of peritonealdialysis (PD). Biological and psychosocial barriers to dialysis initiation had to be tackled across settings in a collaborative, multi-disciplinary manner aligning various stakeholders. These included initial delirium that affected his mental capacity regarding placement and treatment, and concern regarding potential contraindications to PD. At the patient level, family physicians (FPs) are wellplaced to assess the mental capacity of patients, advocating and communicating their capacitated preferences to all stakeholders, collaborating with relevant subspecialists for dialysis initiation, and comanaging with community FP partners as medical experts in the anticipatory transitional care for patients with rapidly progressive end-stage renal failure (ESFR). The role of IPCARE as a systemic key enabler is also discussed. SFP2021; 47(8) : 31-35

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我想再写一本书——《因终末期肾衰竭的快速进展而需要快速腹膜透析的高危老年人的综合初级保健》

一位84岁的糖尿病肾病5期慢性肾脏疾病(CKD)患者因体液过多多次住院，需要在社区医院降压。肾功能下降超过腹膜透析(PD)开始预约。透析启动的生物和社会心理障碍必须通过协调各利益相关者的协作、多学科方式解决。这些包括最初的谵妄，影响了他在安置和治疗方面的精神能力，以及对PD潜在禁忌症的担忧。在患者层面，家庭医生(FPs)可以很好地评估患者的心理能力，向所有利益相关者倡导和传达他们的能力偏好，与相关的亚专科医生合作进行透析启动，并作为医学专家与社区FP合作伙伴一起管理快速进展的终末期肾衰竭(ESFR)患者的预期过渡护理。本文还讨论了IPCARE作为系统关键推动者的作用。SFP2021;47(8): 31-35

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The Singapore family physician

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