An Education Initiative Modifies Opinions of Hemodialysis Nurses towards Home Dialysis

Phillips, Matthew; Wile, Colleen; Bartol, Carolyn; Stockman, Cynthia; Dhir, Minakshi; Soroka, Steven D.; Hingwala, Jay; Bargman, Joanne M.; Chan, Christopher T.; Tennankore, Karthik

doi:10.1186/s40697-015-0051-z

Cited by 13 publications

(15 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Physicians may not have the time in a busy office schedule to educate; nephrology practices may not totally embrace educational programs offered by large dialysis organizations (LDOs), yet not have a structured program themselves; short office sessions may be insufficient to achieve adequate education; and lack of experience or confidence in PD may prevent effective discussion of this option with patients and families. The opinions of ICHD nurses toward home modalities can also have a negative impact on PD growth . As noted in a previous publication and depicted in Fig.…”

Section: Positioning Modality Selection Within An Integrated Kidney Cmentioning

confidence: 66%

Changing Landscape for Peritoneal Dialysis: Optimizing Utilization

Schreiber¹

2017

Seminars in Dialysis

View full text Add to dashboard Cite

The future growth of peritoneal dialysis (PD) will be directly linked to the shift in US healthcare to a value-based payment model due to PD's lower yearly cost, early survival advantage over in-center hemodialysis, and improved quality of life for patients treating their kidney disease in the home. Under this model, nephrology practices will need an increased focus on managing the transition from chronic kidney disease to end-stage renal disease (ESRD), providing patient education with the aim of accomplishing modality selection and access placement ahead of dialysis initiation. Physicians must expand their knowledge base in home therapies and work toward increased technique survival through implementation of specific practice initiatives that highlight PD catheter placement success, preservation of residual renal function, consideration of incremental PD, and competence in urgent start PD. Avoidance of both early and late PD technique failures is also critical to PD program growth. Large dialysis organizations must continue to measure and improve quality metrics for PD, expand their focus beyond the sole provision of PD to holistic patient care, and initiate programs to reduce PD hospitalization rates and encourage physicians to consider the benefits of PD as an initial modality for appropriate patients. New and innovative strategies are needed to address the main reasons for PD technique failure, improve the connectivity of the patient in the home, leverage home biometric data to improve overall outcomes, and develop PD cycler devices that lower patient treatment burden and reduce both treatment fatigue and treatment-dependent complications.

show abstract

Section: Positioning Modality Selection Within An Integrated Kidney Cmentioning

confidence: 66%

Changing Landscape for Peritoneal Dialysis: Optimizing Utilization

Schreiber¹

2017

Seminars in Dialysis

View full text Add to dashboard Cite

show abstract

“…recognition of home dialysis' underuse, 2,26,27 with educational initiatives by many organizations (including the National Kidney Foundation, the International Society for Peritoneal Dialysis, the American Society of Nephrology, universities, and dialysis providers) aimed at alleviating nephrologists' and nephrology trainees' discomfort with prescribing home modalities. [28][29][30] Although the PPS only directly incentivized home dialysis use in United States patients with Medicare Parts A and B, we also found that the PPS was associated with increased home dialysis use in incident patients with other forms of insurance in the United States. Because United States patients with Medicare constitute the majority of patients at most dialysis facilities, we hypothesize that the PPS catalyzed a significant change in provider attitude toward the entire dialysis population.…”

Section: Discussionmentioning

confidence: 62%

Home Dialysis in the Prospective Payment System Era

Lin

Cheng²,

Chin

et al. 2017

JASN

View full text Add to dashboard Cite

The ESRD Prospective Payment System introduced two incentives to increase home dialysis use: bundling injectable medications into a single payment for treatment and paying for home dialysis training. We evaluated the effects of the ESRD Prospective Payment System on home dialysis use by patients starting dialysis in the United States from January 1, 2006 to August 31, 2013. We analyzed data on dialysis modality, insurance type, and comorbidities from the United States Renal Data System. We estimated the effect of the policy on home dialysis use with multivariable logistic regression and compared the effect on Medicare Parts A/B beneficiaries with the effect on patients with other types of insurance. The ESRD Prospective Payment System associated with a 5.0% (95% confidence interval [95% CI], 4.0% to 6.0%) increase in home dialysis use by the end of the study period. Home dialysis use increased by 5.8% (95% CI, 4.3% to 6.9%) among Medicare beneficiaries and 4.1% (95% CI, 2.3% to 5.4%) among patients covered by other forms of health insurance. The difference between these groups was not statistically significant (1.8%; 95% CI, -0.2% to 3.8%). Conversely, in both populations, the training add-on did not associate with increases in home dialysis use beyond the effect of the policy. The ESRD Prospective Payment System bundling, but not the training add-on, associated with substantial increases in home dialysis, which were identical for both Medicare and non-Medicare patients. These spill-over effects suggest that major payment changes in Medicare can affect all patients with ESRD.

show abstract

“…There may be greater risk of training failure in doing so, but it allows for objective evaluation of the patient’s ability to undertake self-care HD [ 12 ]. A recent study has established that an education initiative can modify the opinions of in-centre HD nurses towards home modalities and this should be incorporated into the many strategies for expanding a home HD programme [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary staff attitudes to home haemodialysis therapy

Jayanti¹,

Foden

Mitra³

2017

Clinical Kidney Journal

View full text Add to dashboard Cite

Background: More than a decade after the National Institute for Health and Clinical Excellence recommendation of home haemodialysis (home HD) for 10–15% of those needing renal replacement therapy, the uptake across different regions in the UK remains uneven. Methods: This survey is part of the Barriers to Successful Implementation of Care in Home Haemodialysis (BASIC-HHD) study, an observational study of patient and organizational factor barriers and enablers of home HD uptake, in the UK. The study centres had variable prevalence of home HD by design [low: <3% (2), medium: 5–8% (2) and high: >8% (1)]. This survey was administered electronically in 2013, and had 20 questions pertaining to home HD beliefs and practices. A total of 104 members of staff across five study centres were approached to complete the survey. Results: The response rate was 46%, mostly from experienced HD practitioners. Most believed in the benefits of home HD therapy. Across all centres, respondents believed that preconceptions about patients’ and carers’ ability to cope with home HD (35% to a great or very great extent) and staff knowledge and bias influenced offer of home HD therapy (45%). Also, compared with respondents from high prevalence (HP) centre, those from low prevalence (LP) centres felt that display and presentation of dialysis information lacked clarity and uniformity (44% versus 18%), and that a better set-up for training patients for self-care HD was required (72.8% versus 33.3%). A greater proportion of respondents from the HP centre expressed concerns over caregiver support and respite care for patients on home HD (63.7% versus 33.3%). Conclusions: Survey results indicate that across all centres in the study, there is an appetite for growing home HD. There are some differences in attitudes and practice between LP and HP centres. There are other domains where all centres have expressed concern and addressing these will be influential in navigating change from the current course.

show abstract

An Education Initiative Modifies Opinions of Hemodialysis Nurses towards Home Dialysis

Cited by 13 publications

References 30 publications

Changing Landscape for Peritoneal Dialysis: Optimizing Utilization

Changing Landscape for Peritoneal Dialysis: Optimizing Utilization

Home Dialysis in the Prospective Payment System Era

Multidisciplinary staff attitudes to home haemodialysis therapy

Contact Info

Product

Resources

About