GUIDE, a structured pre-dialysis programme that increases the use of home dialysis

Abstract

BackgroundDespite the many advantages it offers, the percentage of dialysis patients that receive home dialysis [peritoneal dialysis (PD) or home haemodialysis (HHD)] in the Netherlands has declined over the last decade. Pre-dialysis education could stimulate the use of home dialysis. This article presents the results of the pre-dialysis programme GUIDE, with regard to the following question: Does the implementation of a structured pre-dialysis programme with a home-focused approach increase the number of pre-dialysis patients that choose and receive home dialysis?MethodsThe GUIDE process starts when a patient has an eGFR of 15 mL/min/1.73 m2. The process begins with a home visit from a case manager and the completion of questionnaires by the patient, the case manager and the nephrologist. A multidisciplinary meeting (MDM) is held to determine a specific patient profile (or treatment recommendation). This is followed by patient education, a second MDM and finally the selection of the treatment by the patient and the nephrologist. This retrospective observational study describes the selection process of all patients that received a treatment recommendation between 12 September 2013 and 18 December 2014 at Meander Medical Centre. Data were collected by file research and analysis of questionnaires.ResultsOne hundred and two patients were included. They started the process at a mean eGFR of 12.3 mL/min/1.73 m2. Home dialysis was recommended for 62.8% of the patients who were advised to have dialysis treatment. Of the patients that opted for dialysis, 34.2% chose PD and 8.2% chose HHD; 22.9% started home dialysis as their first therapy, compared with 17.6% in the months before implementation of GUIDE. Finally, 32.1% of the patients that received dialysis therapy received home dialysis. In the months before GUIDE, an average of just 19.5% of the patients that received dialysis received home dialysis.ConclusionsIn comparison to historical data, the pre-dialysis programme GUIDE increases the number of patients that choose and receive home dialysis.

Remote Management for Peritoneal Dialysis: A Qualitative Study of Patient, Care Partner, and Clinician Perceptions and Priorities in the United States and the United Kingdom

“…5,[24][25][26] Remote management holds the potential to reduce health care provider concerns of treatment completion and concordance, thereby increasing PD use. 7,[27][28][29] Results suggest that programs seeking to expand home dialysis 30 begin with an assumption of patient suitability, offering shared treatment decision making and tailored support in using a home modality, rather than starting with the assumption of nonsuitability.…”

Implementing Assisted Peritoneal Dialysis in Renal Care: a Chinese-German Perspective

“…Structured educational programmes are advised and resulted in increasing use of home dialysis [29,30]. Financial disadvantages in patients by spending higher rates of out-ofpocket costs may be a considerable problem in countries with restricted health care funding.…”

Dialysis modality selection: physician guided or patient led?

“…In this issue of CKJ , De Maar et al [14] describe ‘GUIDE, a structured pre-dialysis program that increases the use of home dialysis’. In the article, the authors describe a retrospective analysis of outcomes in patients with advanced chronic kidney disease subject to a novel structured pre-dialysis education programme, termed ‘GUIDE’.…”

“…Such flow analysis might also identify where extra numbers of home therapy patients were recruited from in programmes where this is promoted. Reproducing the flow diagram as from the current article may be an instructive undertaking for many renal services [14], and similar previous initiatives have suggested this [2]. …”

“…These include a feeling of fear, insufficient education or lack of confidence leading to ultimately declining home therapy when recommended or failing to start on it even having apparently chosen it [14]. These latter reasons would appear particularly amenable to intervention by structured pre-dialysis education; however, if patients are reporting such problems even after structured pre-dialysis education then the programme itself would seem to require at least some adjustment.…”