[Evaluation of the needs of a population of hemodialysis patients in Rhône-Alpes]. / Evaluation des besoins en soins d'une population de patients hémodialysés en Rhône-Alpes.

The evaluation of the needs of patients with terminal renal insufficiency is necessary to determine the appropriate care programme. An evaluation of the medical and nursing needs, as well as those related to handicap (a total of 47 items) was undertaken on all hemodialysis patients in the Rhône-Alpes region. Only 34.4% were free of co-morbidity and 35.7% of significant handicap, 63.7% needed no other nursing care than that related to supervision of the dialysis and 16.9% were free of all the conditions studied. The patients treated in the centre required care needs than those treated in all other structures. The autodialysis population differs from that treated at home by a greater need for care due to handicaps, and from that treated in a dialysis centre by a lesser degree of handicap and less need for medical treatment. A level of theoretical unsuitability (needs incompatible with the statutory provisions for each type of treatment) was defined: it concerns 5% of the population in a dialysis centre and to 33% of the population on home dialysis. The needs evaluation grid could be used to quantify the requirements of a dialysis population and to arrange for the necessary resources.

[A tool to predict the resources necessary for the whole hemodialysis population]. / Un outil de prédiction des moyens requis pour l'hémodialyse à l'échelon d'une population.

Predicting the resources necessary for the treatment of terminal renal insufficiency requires an understanding of the needs of the whole dialysis population. This study evaluates the advantages of a complete evaluation grid for care needs (CG, 47 items) compared with a simplified version (SG) and with the data obtained from REIN (R) as a tool for predicting the required resources. Compared to CG, the two other classifications under-estimate the level of care needed and the prevalence of patients who have at least one condition resulting in an 'excess' of needs. In a system with three types of structures, the theoretical distribution of patients according to the CG is: in structure A (permanent medical presence): 43.4% (vs 39 for SG and 21% for R); in structure B (intermediate): 34% (vs 31.5 and 24.7% respectively); and in structure C (independent): 22.3% (vs 29.5 and 53.5%) of patients. The care needs scores of populations assigned by R to home dialysis are incompatible with the resources allocated to it. With a certain number of adjustments and qualifications, a population study using a simplified needs grid could enable a prediction of the resources which need to be provided. The patients' records which take precedence in the future REIN should be modified in order to make possible a regular evaluation of the appropriateness of the resources allocated.