The use of virtual physician mentoring to enhance home dialysis knowledge and uptake

Abstract

Home dialysis therapies are flexible kidney replacement strategies with documented clinical benefits. While the incidence of end-stage kidney disease continues to increase globally, the use of home dialysis remains low in most developed countries. Multiple barriers to providing home dialysis have been noted in the published literature. Among known challenges, gaps in clinician knowledge are potentially addressable with a focused education strategy. Recent national surveys in the United States and Australia have highlighted the need for enhanced home dialysis knowledge especially among nephrologists who have recently completed training. Traditional in-person continuing professional educational programmes have had modest success in promoting home dialysis and are limited by scale and the present global COVID-19 pandemic. We hypothesize that the use of a 'Hub and Spoke' model of virtual home dialysis mentorship for nephrologists based on project ECHO would support home dialysis growth. We review the home dialysis literature, known educational gaps and plausible educational interventions to address current limitations in physician education. K E Y W O R D S home dialysis, home haemodialysis, peritoneal dialysis, project ECHO, virtual mentorship | INTRODUCTIONThe Advancing American Kidney Health (AAKH) Initiative 1 in the United States has clearly signalled that home dialysis uptake needs to increase. The nephrology community has been challenged to provide either a kidney transplant or a home dialysis modality for 80% of patients requiring end-stage kidney disease (ESKD) care by 2025. Home dialysis therapies (home haemodialysis [HHD] and peritoneal dialysis [PD]) are cost-effective 2 and highly preferred modalities of renal replacement therapies when nephrologists and patients are surveyed. [3][4][5][6][7][8] Home dialysis therapies have been associated with improved quality of life, 9 greater satisfaction with therapy, 9 and improved blood pressure control. 10 Patients on HHD have reductions in left ventricular mass 10 while patients on PD have improved preservation of native kidney function when compared to patients on incentre haemodialysis (ICHD). 11 This has led nephrologists and professional bodies to adopt a 'Home First' culture when educating patients about kidney replacement therapies. 3 The incidence and prevalence of home dialysis therapies vary internationally and are explained by various clinical, social and economic factors. 12 We acknowledge that the barriers to home therapies will differ in different contexts. However, the relatively low rates of home dialysis therapies in the United States warrant further attention. According to the most recent USRDS data, 13,14 approximately 85% of incident ESKD patients in the United States begin ICHD as the initial mode of therapy. Only 10.9% of the incident ESKD population in 2018 initiated PD and even fewer initiated HHD as initial therapy (0.3% of incident patients with ESKD).The low rates of home modality uptake in the United States are not fully explained by c...

The Implementation of a Virtual Home Dialysis Mentoring Program for Nephrologists

“…We have previously published our rationale and methods in detail (3). In brief, we used an online audio-video platform to bring expert mentors together with participants for 12 sessions, conducted every 2 weeks over a 6-month period.…”

“…One of the recognized barriers to greater adoption in the United States is nephrologist comfort and confidence with managing home modalities (2). To enhance knowledge awareness and practice patterns, we proposed the development of a virtual home dialysis mentorship program for nephrologists on the basis of the principles of Project ECHO (NCT04806126) (3).…”

Utilization of Peritoneal Dialysis in the United States: Progress in Tackling Obstacles to Expansion

“…Other resources available for both aspiring and current nephrologists to acquire or sharpen their home dialysis knowledge base include Home Dialysis University, PD University, PD Academy of Excellence, Home Dialysis Academy of Excellence, Home Dialysis Academy, and the ASN Virtual Mentor Curriculum. Other initiatives available include online modules, in-person 2- to 3-day workshops, and programs with both online and in-person components (27). One of the latest innovations is project ECHO, which connects practitioners in rural and underserved areas to specialists in tertiary centers for the care of patients with hepatitis C (28)—a model coined ‘hub and spoke.’ This model has been adopted by many health care professionals across different fields with moderate success.…”

“…One of the latest innovations is project ECHO, which connects practitioners in rural and underserved areas to specialists in tertiary centers for the care of patients with hepatitis C (28)—a model coined ‘hub and spoke.’ This model has been adopted by many health care professionals across different fields with moderate success. Perhaps using this model to develop a virtual home dialysis mentoring program for physicians whereby attendees are provided interactive, live didactic learning session via an online video meeting platform is another avenue that can be explored in growing the home dialysis knowledge base for practicing nephrologists in geographically isolated areas (27).…”

Home Dialysis Curriculum Implementation for Health Care Workers Using Project ECHO Principles: A Feasibility Report From NKF-KDOQI

“… 12 The NKF–Home Dialysis Project ECHO fulfills the perquisites for an accessible, broad-based virtual clinical education platform. 13 …”