205 association with research on its impacts. To achieve implementation, GoYK needs to be incorporated into health guidelines and reimbursement schedules by healthcare financers. GoYK can then be easily implemented, with a minimum burden for patients and professionals, since it has been designed to be integrated into standard CKD care. Interventions such as GoYK are extremely important given that initiatives focused on the prevention of CKD progression are often scattered, inadequate, and incongruent, despite their potential for reducing disease burden and societal costs[2,52]. Thus, GoYK represents a means to target social determinants of health and promote disease prevention, with consequent improvements in health[53,54]. Given the uncertainties present in our analysis, the implementation of the intervention should be combined with research on the intervention’s effect for a longer period in a larger number of individuals. That could enable a better estimation of the effect of the intervention on clinical outcomes, such as eGFR and health behaviors, and the identification of subgroups that could benefit most from the intervention, e.g. patients recently diagnosed with CKD. Moreover, the (cost-)effectiveness of such a multi-component health literacy intervention should be tested in other countries, to assess if it is suitable for other cultures and healthcare system configurations. Finally, as GoYK covers skills that are also useful in the management of other chronic diseases, similar interventions could be tested for other conditions, such as cardiovascular disease, COPD, and cancer. CONCLUSION GoYK, a multi-component health literacy intervention for CKD patients and healthcare professionals, seems to lead to large cost-savings across the life course of CKD patients, and to a substantial reduction in mortality and need for dialysis, compared to care-as-usual. We recommend the implementation of GoYK by healthcare organizations and its incorporation into health guidelines and reimbursement schedules. Given the novelty of our study, the implementation of GoYK should be combined with further research on its longterm effects and subgroups that could benefit the most from it.
RkJQdWJsaXNoZXIy MTk4NDMw