ABSTRACT
BACKGROUND: Home dialysis, including both peritoneal and haemodialysis, has been shown to improve patient wellbeing as well as being an economically beneficial alternative to hospital-based therapies. OBJECTIVES: This paper discusses the major barriers to home therapies, particularly in relation to home haemodialysis (HHD) and systems that can be used to overcome them. RESULTS: The use of HHD varies considerably between and within countries. The major limitation is lack of experience and education. A well-planned pre-dialysis education programme seems to be one essential key to the growth of home therapies. CONCLUSIONS: Key points in providing a successful home therapy programme are a highly motivated multidisciplinary team including a dedicated nephrologist and high-level nursing expertise. In addition, an effective pre-dialysis education programme for identifying suitable patients is required.
Subject(s)
Hemodialysis, Home/nursing , Kidney Failure, Chronic/nursing , Patient Education as Topic , Peritoneal Dialysis, Continuous Ambulatory/nursing , Self Care , Arteriovenous Shunt, Surgical/nursing , Arteriovenous Shunt, Surgical/psychology , Cooperative Behavior , Hemodialysis, Home/methods , Hemodialysis, Home/psychology , Humans , Interdisciplinary Communication , Kidney Failure, Chronic/psychology , Patient Acceptance of Health Care/psychology , Patient Education as Topic/methods , Patient Selection , Peritoneal Dialysis, Continuous Ambulatory/methods , Peritoneal Dialysis, Continuous Ambulatory/psychology , Self Care/methods , Self Care/psychology , United KingdomABSTRACT
BACKGROUND: Home haemodialysis (HHD) and self-care satellite dialyses (SHD) have been suggested to offer significant benefits over conventional in-centre haemodialysis. However, little is known about differences between these two modalities. The purpose of the study was to analyse costs and health-related quality of life (HRQoL) of HHD and SHD. METHODS: On 15 October 2004, a total of 65 patients attended self-care haemodialysis in the area. Of those patients, 33 were on HHD and 32 on SHD. Cost data were collected from those study patients who were on dialysis the whole calendar year 2004 (23/33 HHD and 28/32 SHD patients). HRQoL was measured by the generic 15D instrument. The questionnaire was administered to all the study patients. A total of 23/33 of HHD and 24/32 of SHD patients returned the questionnaire. RESULTS: Direct medical costs of dialysis and hospital treatment were higher in HHD (31 834 +/- 6046 EUR/year, mean +/- SD) than in SHD (27 528 +/- 4325), P < 0.005. By contrast, travel costs were lower in HHD (426 +/- 743 EUR/year) than in SHD (5228 +/- 4236), P < 0.001. Costs of pharmaceuticals did not differ significantly. There was no significant difference in the total costs between HHD and SHD (38 477 +/- 7685 and 39 781 +/- 10 226 EUR/year), P = not significant. There were no significant differences in the total 15D score or in the 15 dimensions of the 15D instrument between home and satellite patients. CONCLUSIONS: HHD and SHD are, from the patient's perspective, equally effective in providing health. Although there were significant differences in the distribution of costs (which needs to be taken into account when evaluating different treatment strategies), total costs were similar. However, in the HHD setting, patients had on average more and longer sessions. Patient preference should be the main decisive factor when choosing between home or satellite haemodialysis.
Subject(s)
Cost of Illness , Hemodialysis, Home/economics , Kidney Failure, Chronic/economics , Quality of Life , Self Care/economics , Adult , Age Factors , Aged , Chi-Square Distribution , Cost-Benefit Analysis , Evaluation Studies as Topic , Female , Finland , Health Services Accessibility , Hemodialysis, Home/methods , Hospitals, Satellite/economics , Humans , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/therapy , Linear Models , Male , Middle Aged , Patient Satisfaction , Probability , Risk Assessment , Severity of Illness Index , Sex Factors , Surveys and QuestionnairesABSTRACT
The discussion was initiated by a paper on the influence of a pre-dialysis education programme on the mode of renal replacement therapy by Goovaerts et al (NDT 2005). Barriers to the uptake of self-care treatment modalities, including late referral, limited availability of treatment options, reimbursement, support from staff and families, the requirement for a helper and the length of the training programmes for home haemodialysis (HD) were discussed by 21 participants from 12 countries. The 'take-home' messages from the discussion were that to optimise the uptake of self-care modalities, renal units should try to ensure the all patients who are able to choose are fully informed before starting dialysis, even if they are referred to the unit very late. Offering a wide range of treatment options to new patients, and allowing (or encouraging) home HD without a helper, may also increase the number of patients who start and stay on a self-care modality. It should be possible to provide an acceptable level of training, without compromising on safety, within 3 weeks if the patient is confident with needling.