Getting Off to the ‘RightStart’

By Raymond M. Hakim, MD, PhD and Rebecca Wingard, RN, MSN, CNN

Taking control of your healthcare with RightStart

When she first started dialysis treatments, Maurita felt like there was a black cloud over her head. That’s until she started the RightStart Program*, an educational plan being tried in some clinics that helps patients starting dialysis better understand their dialysis treatment. Once she finished the program, she actually started looking forward to going to her treatments because she understood that they were helping her lengthen her life, to continue being with her family. Now, she even provides encouragement to other new patients. She says she hasn’t felt this good in a long time.

Do you remember how you felt when you started dialysis? Anxious, scared, and with endless questions? This new program called “RightStart,” is designed to educate and help new patients feel better and more in control of their health during this critical time.

Making Learning Easier
There’s a lot to learn as a new patient. That’s why the RightStart Program provides information in an easy-to-understand, step-by-step format. For the first four months of dialysis treatment, a RightStart case manager visits new patients and reviews educational material from a handbook that addresses topics new patients need to know about. This provides patients with information on treatments, how to take medicines, what those medicines are for, how to get more physically active, and more.  It gives new patients the knowledge they need to better manage their own health.

The RightStart case manager not only works with the material from the handbook, but also reviews the medical record and treatment plan, and gives input to the rest of the healthcare team. These case managers have developed good teaching and communication skills. When an interested patient has a skilled case manager and good teaching materials, the results can be great! Patients learn the “ins and outs” of their treatment, medications, blood access care, and more – but most importantly, they are taught how to be in control and take better care of their health for the long run.

Since about half of dialysis patients also have diabetes, the program also has a special focus on what the patient with diabetes needs to know – simple things like checking feet for sores and an awareness of any loss of sensation that can be common in diabetes patients.

“The more information I have, the better it helps me to deal with all of this,” says Maurita. “Before I started I thought- ‘This can’t be happening to me.’ The RightStart Program teaches you to deal with dialysis in a very positive way.”

A Patient Focused Program
The RightStart Program is based on facts learned from research. This knowledge is used to find actions patients can take against risks. For example, did you know that your health and long life are at risk if you…



Skip or shorten dialysis treatments

Come for all treatments and stay your full time

Have poor eating habits

Don’t skip meals and follow your dietitian’s advice

Use a catheter for your access

Ask your doctor about getting a different access

Skip your daily foot check if you have diabetes

Learn how to check your feet daily, apply lotion, and prevent sores


Tom, another patient who has finished the RightStart Program, says, “The program has taught me for the first time how to understand my condition and all the pieces and parts that make it up. It doesn’t just tell me to don’t do this or that, but it explains why. It also tells me what I can do, and helps me develop good healthy habits. Dialysis is no longer a ‘sentence’ but a treatment that is good for me. The average person has no idea.”

You Can’t Beat a Team Approach – With YOU in the Driver’s Seat!

“Taking charge” of your health means learning about your condition and how to work well with the healthcare team. RightStart teaches how each team member in the clinic is there to help you; from the receptionist to the social worker, the dietitian to the nurse, the technicians, doctors and more! Each person is highly trained in their area of expertise, and the patient learns how to best work with each team member.

One way to do this is to make a checklist of things to ask about when you come to the clinic, especially on days when the doctor will be there. Keep the list on a card or something you can keep in your pocket, wallet or purse. Here’s a sample list – can you fill in which team member could help you most? If you’re not sure, ask someone at your clinic. If you keep up with your list every treatment, it will get shorter and you will be solving small problems before they become big. Start a habit of making a list, and be specific about what you need or how you are feeling. You are already taking charge of your health!

Taking Charge and Staying Motivated
When Brenda started dialysis treatment, she committed to the RightStart Program without a second thought. “Once I heard about it I knew I had to do it to keep me going and make me feel better,” she says. “I feel so good now it’s kind of scary. I’m active all the time now – much more than before I started dialysis.”

What Brenda liked most about the RightStart Program was that it encouraged patients to take charge of their own health. “It really kept me motivated,” she says. “It taught me to want to be healthier. It probably would have been much harder to get used to dialysis without RightStart.” Be committed to learning, working well with your healthcare team, and following your treatment plan. You will feel healthier and cope better with the challenges of being a new patient.

*The RightStart Program is new at Fresenius Medical Care, and there may not be a case manager in your clinic at this time. However, your healthcare team is there to help you with anything you may need, and to answer all your questions about your health.

About the Authors
Raymond M. Hakim, MD, PhD is the Senior Executive Vice President, Clinical & Scientific Affairs for Fresenius Medical Care – NA. He did his nephrology fellowship at Harvard Medical School and at Brigham and Women’s Hospital in Boston, Massachusetts in 1980. In 1995, Dr. Hakim became one of the founders and Chief Medical Officer of Renal Care Group which merged with Fresenius Medical Care-NA in April 2006. Dr. Hakim has presented extensively and has written over 120 articles regarding issues in dialysis as well as contributing chapters to over 30 books.

Rebecca Wingard, RN, MSN, CNN is VP, Quality Initiatives for Fresenius Medical Care, and manages the RightStart Program. Her background is in nursing, with experience in quality management, patient education, clinical research, hemo- and peritoneal dialysis, and critical care. She has been an author in many scientific journal articles, and has been a professional speaker within and outside the U.S.

Uploaded: 1-5-2008

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