Putting patients first

November 22, 2017

Although Rachael Walker’s PhD. research into kidney dialysis preferences for patients answered many questions, it raised many more providing the scope for future research.

 In July 2017, Rachael was awarded her PhD. from the University of Sydney. The focus of her PhD. by publication, was to discover what matters to patients and their whānau in choosing their preferred type and modality of dialysis treatment. One of the aims was to discover the barriers in the uptake of home dialysis in New Zealand.  In discussions with patients and whānau, Rachael identified a number of barriers to home dialysis including socio-economic factors and decreased nursing support. The most overwhelming finding for Rachael was the negative experiences of the health care system and how a lack of early information and education had impacted on the disease projectory for these people. She also identified how important it is to include family in the care and decision-making process.  

After conducting qualitative interviews with 52 patients and whānau, Rachael conducted a discrete choice experiment, a quantitative survey method which enables quantification of qualitative data. She found that patients placed a high value on nursing support and on their own quality of life. She also discovered there are many barriers to home dialysis mostly relating to socio-economic disadvantage, as there are a number of out-of-pocket costs for the patient. As a result, her recommendations included ways to align policy and services to better meet patients’ needs and preferences. Part of the research looked at ways patients could access nursing support at home. Increasingly, information technology is assisting with remote patient monitoring and this is an area that could have a growing impact on improving access and reducing inequities.

Rachael is a newly-appointed Associate Professor within the School of Nursing. She is also heading EIT’s registered nurse prescribing programme and believes an essential way to provide quality care is to understand patients’ needs and preferences  In 2010, Rachael became New Zealand’s first renal Nurse Practitioner which means she can autonomously assess, diagnose and prescribe to patients who have kidney disease. An important part of her work is to educate others on healthy lifestyle choices and disease prevention. This is important as kidney disease has a huge impact on the health system accounting for 1-2% of the health dollar. The number of patients requiring dialysis in New Zealand has increased significantly in recent years. About half of all dialysis patients have diabetes as a primary cause. Rachael continues to do one day of clinical work with the District Health Board which she feels adds credibility to her research and allows her to maintain a clinical focus. In her new role she is enjoying the freedom and flexibility to focus on health-related research as well as enjoying working on projects with other institutions. Rachael’s work has been published internationally and it is a topic that has international application.

Associate Professor Dr Rachael C. Walker
The Home First Study: Patient preferences for dialysis modality
A mixed-method study