Prof Paul Bennett1,2, Satellite Healthcare Denise Eilers3, Ms Fang Yang1, Ms Christie Price-Rabetoy4
1Satellite Healthcare, San Jose, United States, 2Deakin University, Geelong, Australia, 3American Nephrology Nurses Association, Pitman, United States, 4United Township Area Career Center, Davenport, United States
Background: Globally, home dialysis prevalence has been declining relative to the increase in renal replacement therapy. The decline has also seen the development of varying program policies concerning: staff home visits; telehealth; solo dialysis; patient costs; and training flexibility. The goal of this study was to explore global home dialysis clinician views and program policies to identify preferred practices.
Methods: A 13 item web-based questionnaire was disseminated to home therapy program clinicians in the 50 highest home dialysis prevalence nations worldwide. Questions related to patient reimbursement, telehealth, patient training, home and clinic visits were explored. Surveys were translated into 9 languages. Human ethics board approval was received.
Results: 395 respondents from 30 nations using 8 different languages responded. 64% provided both HHD and PD, 29% PD only and 7% HHD only. 29% had less than 20 patients, 30% 20 to 50 patients, 22% 50 to 100 patients and 19% greater than 100 patients. Global telehealth use was low (23%) contrasting with 83% respondents agreeing telehealth would improve care. Only 31% of all programs enabled flexible training out of work hours. 31% of all program patients had some cost reimbursement, with a significant difference between US (11%) and non-US programs (59%), (χ2=93.6, p<0.0001). Significant differences in need for monthly check up (US 72%, non-US 44%, χ2 = 83.7, p<0.0001) were found.
Conclusion: Global variations in home therapy protocols and perspectives exist. Telehealth and cost reimbursement are low and vary. Addressing these hurdles to home dialysis may increase uptake and modality success.
Paul Bennett is the Director of Medical & Clinical Affairs at Satellite Healthcare. Based in California, Satellite is a non-profit provider who manage 85 dialysis and home training centers across the US. Paul is the current Chair of the International Society of Nephrology Kidney Health Professionals Working Group and Co-Chair of the Global Renal Exercise (GREX) group.