Home Hemodialysis in the Remote Canadian North: Treatment in Manitoba Fly‐in Communities

Abstract

Manitoba has the highest prevalence of ESRD in Canada. Northern Manitoba is a very sparsely settled area with a high proportion of aboriginal ESRD patients. Relocating to urban areas for dialysis is psychosocially and culturally stressful to patients. Delivering dialysis care in a home setting has demonstrated advantages in both clinical, economic, and health related quality of life domains. Establishing home hemodialysis in very remote communities has significant challenges, including poor and inadequate housing, unreliable water supply, limited community medical backup, and poor road access to communities especially for delivery of supplies. These challenges necessitate the development of strong community partnerships, and well documented processes for contingencies. A dedicated interdisciplinary support and training team at the urban hub is essential.

Identifying barriers to healthcare delivery and access in the Circumpolar North: important insights for health professionals

“…Seven articles directly addressed the barriers created by travel and delivery costs to northern regions [6,23,27,28,34,43,44]. Low population density and communities scattered over vast geographical distances contribute to costly transportation [43].…”

“…Low population density and communities scattered over vast geographical distances contribute to costly transportation [43]. In order to service these large areas, higher costs are required for patient and healthcare provider travel and for the delivery of medical supplies and equipment [27,43,44]. It was found that particularly within North America, increased use of air travel was common and expensive [6,27].…”

“…The majority of articles (33 of 43) addressed barriers to healthcare delivery and access that were related to healthcare professionals specifically [6,7,[10][11][12][13][14]17,[19][20][21][22][24][25][26][27][28][29][30][33][34][35][36][37][38]40,42,[44][45][46][47][48][49]. Practitioner-related barriers included staff shortages and high staff turnover, as well as lack of training, professional knowledge, skills and clinical expertise in treating specific medical conditions and working in areas that are distant from urban centres.…”

“…Many studies identified high staff turnover as a barrier to healthcare accessibility in the Circumpolar North [6,10,12,14,17,19,22,25,26,30,42,44,46]. Reasons identified as contributing to staff retention difficulties included the relative isolation of communities, being at a long distance from family, experiencing a lack of professional support and resources, and facing challenges in pursuing education for professional development [12,26,30,42].…”

Current Status Of Alternative Hemodialysis Regimens: An Introduction

“…The issue then turns to practical aspects of intensive hemodialysis provision. Zacharias et al (17) describe strategies to make home hemodialysis accessible to patients living in geographically isolated communities in northern Manitoba, Canada. The unprecedented success of intensive and home hemodialysis in Australia and New Zealand is chronicled by Agar et al (18).…”