May 1, 2007

Home care assistance and the utilization of peritoneal dialysis.

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Peritoneal Dialysis
  • Guest

    The accompanying editorial to this paper seemed to suggest that pushing home PD may be in direct competition with home hemodialysis. My feeling is that many patients who might benefit from home care assisted PD would not be candidates for home hemodialysis, and that in fact, there would be very different pools of candidates for home hemodialysis and home care assisted peritoneal dialysis.

    What do others think?

  • Guest

    I am a big supporter of home based care. I see the strong positives in patient outcomes. Although the push for home based care may take a load off of the acute care sector, doesn’t it just displace the cost onto the consumer (in this case the elderly)?

    Many of my clients would prefer to have treatment at home but opt for treatment in hosptial instead simply due to cost. The move to home based care also seems to be a move towards a larger privitized system. Correct me if I am wrong, does the movement towards home based care displace cost onto the consumer?

  • Dr. Matthew Oliver

    Thank you for the question.

    We presented the results of our program to our Ministry of Health on multiple occasions and they saw the value of increasing home dialysis. Our government is looking for alternative to continued incentre HD expansion. We are planning on conducting a formal costing analysis in the next year.

    However in the meantime, the main issues are 1) the rate of visits delivered is much less than the maximum of 14 per week 2) patients treated in the home dont require as much capital expenditures similar to HD units 3) it is aligned with their strategy to use home care to offload acute care hospitals 4) it is a model of chronic disease management to keep patients in the home rather than the hospital. We continue to achieve a high incidence of PD and now feel the home care assistance is a key support for home PD as the population ages. We accumulate results and we would be happy to present them to decision makers in your region if that would help get your patients more home support.

  • Guest

    Addressed to Dr. Oliver:

    Our program would be very interested in increasing our PD usage in the elderly. However, our jurisdiction does not provide funding for home care to do this, nor are our home care nurses trained to assist in this way.

    How were you able to convince government to provide funding and training to make such a program viable?

  • Dr. Matthew Oliver

    Thank you for the question.

    The main result of this study was to demonstrate that assistance expands eligibility for PD among patients with barriers to self-care who are primarily elderly. The median age of the assisted patients was around 75 years old. Although I have limited experience with home hemodialysis, my impression is that is serves a much younger population who can perform this highly technical therapy at home. Assisted PD is less complicated and well suited for the elderly population on dialysis which is growing rapidly. For this reason, I think assistance in the future will be viewed as an important service to successfully support elderly patients at home on dialysis.

  • Guest

    Dr. Oliver,

    Congratulations on your publication. I think home care assistance has made a valuable contribution to patients on peritoneal dialysis. However, what impact do you think home care assisted peritoneal dialysis will have on the growth of home hemodialysis?