Pilot study shows staff-assisted PD improves retention
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Patients may have an easier time adhering to peritoneal dialysis and avoiding complications with the use of staff assistance, according to results of a pilot study presented at the virtual Annual Dialysis Conference.
“Assisted [peritoneal dialysis] PD is necessary because of the growing elderly and frail population,” Wael Hussein, MBBS, MSc, MRCPI, vice president of research and development at Satellite Healthcare and an adjunct assistant professor at Stanford School of Medicine, said during a presentation. “PD has clinical and lifestyle advantages...staff assistance offers patient choice [of modalities] and can be tailored to a patient’s needs.”
Hussein said if staff-assisted PD became available, more nephrologists would choose PD for “marginal” patients. In addition, it would prevent partner burnout, reduce the need for back-up hemodialysis and help with patient nonadherence.
“It also would ease the transition of patients moving from in-center dialysis to home therapy.” Hussein said.
Patient selection
Satellite investigators received 52 referrals for the pilot study. Approximately 70% had some type of physical impairment, and the median age was 75 years. Once patients were selected to participate, visits were arranged for once daily by a non-nurse health care worker trained in the use of PD. Telehealth visits were also allowed as part of the study.
“Our objective with this study was to focus on developing self-management skills, improving the environment, and finding support to enable independence from staff assistance,” he said.
Of the study group, eight patients were selected to have staff assistance prior to starting PD, 16 were selected to participate that were in training for PD, and 30 patients were offered assistance who were already on PD but had a medical event where the study investigators thought assistance would be helpful.
Thirteen patients in the referral group did not require assistance once the program started, Hussein said, either because they had found support from a partner at home or had switched to in-center hemodialysis.
Hussein said much of the assistance was directed at helping patients set up the PD equipment and with arranging and storing supplies.
“Sometimes it was just about observing the technique, and making sure things were going well,” Hussein said.
In total, Satellite staff made 369 visits over a median of 17 days. The average time per visit was 60 minutes. Of the visits, 12% were telehealth.
Outcomes
Hussein said patients who received staff-assisted PD experienced no exit site infections or peritonitis. By the end of the study, 94% of patients were discharged from the staff assistance program and were able to continue PD by themselves or with a partner.
The outcomes from the Satellite Healthcare project come at an opportune time, Hussein said, as Congress considers legislation introduced last September that would require Medicare to reimburse providers who provide assistance during home dialysis.
The Improving Access to Home Dialysis Act offers reimbursement for in-home assistance by staff for the first 90 days of home hemodialysis or PD and would expand the types of health care professionals who can provide home dialysis training.
The bill would also require HHS to conduct a study on the racial disparities in the utilization of home dialysis and provide data on outcomes for in-center and home dialysis patients.
“The time is now for us to show the value of staff assistance for patients on home dialysis,” Hussein said.
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Hussein W. Alleviating patient and care partner burden: Experience from the first US-based staff assisted program. Presented at: Annual Dialysis Conference; March 4-6, 2022 (virtual meeting).
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