Programmatic variation in home hemodialysis in Canada: results from a nationwide survey of practice patterns.

Autor:	Pauly RP; Department of Medicine, Division of Nephrology, Northern Alberta Renal Program and the University of Alberta Hospital, University of Alberta, Edmonton, AB Canada., Komenda P; Department of Medicine, Section of Nephrology, University of Manitoba, Winnipeg, MB Canada., Chan CT; University Health Network, University of Toronto, Toronto, ON Canada., Copland M; Division of Nephrology, University of British Columbia, Vancouver General Hospital, Vancouver, BC Canada., Gangji A; Department of Medicine, Division of Nephrology, McMaster University, Hamilton, ON Canada., Hirsch D; Department of Medicine, Division of Nephrology, Dalhousie University, Halifax, NS Canada., Lindsay R; Director Home Hemodialysis, London Health Sciences Centre, Western University, London, ON Canada., MacKinnon M; Division of Nephrology, Horizon Heath, St John Regional Hospital, St John, NB Canada., MacRae JM; Department of Medicine and Department of Cardiac Sciences, Division of Nephrology, Southern Alberta Renal Program, University of Calgary, Calgary, AB Canada., McFarlane P; Department of Medicine, Division of Nephrology, St Michaels Hospital, Toronto, ON Canada., Nesrallah G; The Li Ka Shing Knowledge Institute, Keenan Research Centre, St Michael's Hospital, and Nephrology Program, Humber River Hospital, Toronto, ON Canada., Pierratos A; University of Toronto, Humber River Hospital, Toronto, ON Canada., Plaisance M; Departement de Medecine, Service de Nephrologie, Centre Hospitalier Universitaire de Sherbrooke, Universite de Sherbrooke, Sherbrooke, QC Canada., Reintjes F; Department of Medicine, Division of Nephrology, Northern Alberta Renal Program and the University of Alberta Hospital, University of Alberta, Edmonton, AB Canada., Rioux JP; Department of Medicine, Division of Nephrology, Hopital du Sacre-Coeur de Montreal, University of Montreal, Montreal, QC Canada., Shik J; Department of Medicine, Division of Nephrology, Health Science Centre, Memorial University of Newfoundland, St Johns, Newfoundland Canada., Steele A; Division of Nephrology, Lakeridge Health, Oshawa, ON Canada., Stryker R; Department of Medicine, Division of Nephrology, University of Saskachewan, Saskatoon, Saskatchewan Canada., Wu G; Division of Nephrology, Trillium Health Partners, Mississauga, ON Canada., Zimmerman DL; Department of Medicine, Division of Nephrology, Ottawa Hospital and the University of Ottawa, Ottawa, ON Canada.
Jazyk:	angličtina
Zdroj:	Canadian journal of kidney health and disease [Can J Kidney Health Dis] 2014 Jun 10; Vol. 1, pp. 11. Date of Electronic Publication: 2014 Jun 10 (Print Publication: 2014).
DOI:	10.1186/2054-3581-1-11
Abstrakt:	Background: Over 40% of patients with end stage renal disease in the United States were treated with home hemodialysis (HHD) in the early 1970's. However, this number declined rapidly over the ensuing decades so that the overwhelming majority of patients were treated in-centre 3 times per week on a 3-4 hour schedule. Poor outcomes for patients treated in this fashion led to a renewed interest in home hemodialysis, with more intensive dialysis schedules including short daily (SDHD) and nocturnal (NHD). The relative infancy of these treatment schedules means that there is a paucity of data on 'how to do it'. Objective: We undertook a systematic survey of home hemodialysis programs in Canada to describe current practice patterns. Design: Development and deployment of a qualitative survey instrument. Setting: Community and academic HHD programs in Canada. Participants: Physicians, nurses and technologists. Measurements: Programmatic approaches to patient selection, delivery of dialysis, human resources available, and follow up. Methods: We developed the survey instrument in three phases. A focus group of Canadian nephrologists with expertise in NHD or SDHD discussed the scope the study and wrote questions on 11 domains. Three nephrologists familiar with all aspects of HHD delivery reviewed this for content validity, followed by further feedback from the whole group. Multidisciplinary teams at three sites pretested the survey and further suggestions were incorporated. In July 2010 we distributed the survey electronically to all renal programs known to offer HHD according to the Canadian Organ Replacement Registry. We compiled the survey results using qualitative and quantitative methods, as appropriate. Results: Of the academic and community programs that were invited to participate, 80% and 63%, respectively, completed the survey. We observed wide variation in programmatic approaches to patient recruitment, human resources, equipment, water, vascular access, patient training, dialysis prescription, home requirements, patient follow up, medications, and the approach to non-adherent patients. Limitations: Cross-sectional survey, unable to link variation to outcomes. Competition for patients between HHD and home peritoneal dialysis means that case mix for HHD may also vary between centres. Conclusions: There is wide variation between programs in all domains of HHD delivery in Canada. We plan further study of the extent to which differences in approach are related to outcomes.
Databáze:	MEDLINE
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