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Peritoneal dialysis (PD) is a kidney dialysis method that allows patients to perform their own care independently and at home, instead of in a hospital or clinic setting. However, for PD patients who don’t have the ability to perform the treatment themselves, PD can pose a challenge.
PD patients are often forced to switch to a different dialysis technique or move into long-term care if they are functionally limited (meaning they are restricted in some way from being able to perform the dialysis), and/or lack caregivers who can provide support, even if they are still willing and able to continue with PD. Such a transition is undoubtedly a major loss of independence for these patients, especially for those who are accustomed to and comfortable with being able to carry out their PD by themselves, in their own homes.
PD clinics in BC saw the negative impact these transitions were having on their functionally limited patients and wanted to seek out a way to better support them. As a result, a working group was formed within the BC Provincial Renal Agency to develop and implement Assisted Peritoneal Dialysis as a 12 month pilot project.
Assisted PD uses contracted trained caregivers to help patients continue independent, at-home peritoneal dialysis when they are unable—or become unable—to carry out the treatment themselves. From July 18, 2014 to August 31, 2015, 64 patients at four PD program sites were referred based on specific eligibility criteria to receive support as part of the Assisted PD Pilot Project. Each patient received home visits from caregivers of up to one hour and up to seven days a week. The caregivers assisted the patients providing specific tasks inclusive of equipment set up, treatment, monitoring and cleanup for PD.
The pilot project explored the possibility of Assisted PD in British Columbia from a clinical, financial and qualitative perspective with positive outcomes observed in all areas. As the project was implemented, there was a concerted effort to gather as much qualitative feedback as possible from staff, patients, and caregivers. The comments received were unanimous: increased support provided by caregivers resulted in patients describing considerable relief of disease and care burden. Maintaining independence and in many cases increasing independence was reported to be invaluable to their quality of life. Staff felt that Assisted PD provided much-needed support to functionally limited PD patients and their families, while helping them avoid hospitalizations.
Financial outcomes identified that the cost of Assisted PD was approximately $15,000 per patient per year, but this cost is significantly lower than that of the alternatives: long-term care or hemodialysis (another dialysis technique). Clinically, the patients in the Assisted PD pilot project had lower rates of infection compared to the rate of infection in patients in British Columbia who are considered eligible for Assisted PD. And though patients in the pilot had higher rates of hospitalization, the Assisted PD team attributed the increase to caregivers being able to spot complications that would have otherwise been missed.
The financial benefit from reduced stress on the health care system, the great point-of-care feedback used to design the program, the increased support and ability to self-manage for functionally limited PD patients, and most of all the return to independence that these patients are able to enjoy all make Assisted PD an exceptional program that serves a much-needed gap. Assisted PD has been approved provincially with a plan in place to implement the program across all BC health authorities over the next few years.