Ingrid Ledebo, PhD
Synopsis: Ledebo I. What limits the expansion of self-care dialysis at home? Hemodial Int. 2008 Jul;12 Suppl 1:S55-60.
Self-care dialysis at home, whether peritoneal dialysis or hemodialysis, is more cost-effective than in-center dialysis and treatment outcome is at least comparable. Still, both self-care modalities are considered underutilized and we wished to identify the perceived reasons for this underutilization among nephrology professionals. A questionnaire was distributed at 5 international nephrology meetings in 2006. Questions addressed the most important stakeholders and the most important issues for patients and nephrology professionals to enable the expansion of self-care dialysis and commonly mentioned barriers were given as alternative responses. The proportion of patients considered suitable for self-care was also investigated. Seven thousand responses were collected. The listed stakeholders, i.e., health care and reimbursement authorities, nurses and physicians, and finally patients and their families, are considered approximately equally important for the process. Nephrology professionals feel that patient motivation for choosing and performing self-care dialysis is the strongest driver. The need for dedicated resources for self-care is judged to be vital for the expansion of this modality of treatment. Thirty-two percent of incident patients are considered able to perform self-care dialysis at home. This international survey among 7000 nephrology professionals has identified patient motivation as one of the strongest drivers of self-care dialysis at home. The need for dedicated resources for the staff to devote time to developing such motivation is given as one of the major reasons for the slow adoption. Under ideal conditions, it is felt that one-third of all patients starting dialysis can be trained to perform self-care dialysis.
Commentary by Todd S. Ing, MD
Dr. Ledebo has identified patient motivation and dedicated resources as important ingredients in the promotion of self-dialysis at home. She has also found that many healthcare workers believed that about a third of dialysis patients are capable of dialyzing themselves at home. A home is less prone to harbor antibiotic-resistant micro-organisms than a dialysis center. Flexibility with respect to the frequency and duration of dialysis sessions is another significant benefit of home dialysis. What is more, dialyzing oneself at home can help to ease, albeit in a small way, the huge heathcare financial burden of the world.
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