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Abstract: FR-PO527

Pilot of Assisted PD in an Integrated Health Care System

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Bhalla, Neelam M., The Permanente Medical Group, Hayward, California, United States
  • Arora, Neiha, The Permanente Medical Group, Union City, California, United States
  • Lai, George, The Permanente Medical Group, Hayward, California, United States
  • Benson, Elaine B., Kaiser Permanente , Hayward, California, United States
  • Villaflor, Lerisa Delos santos, Kaiser Permanente, San Leandro, California, United States
  • Lisker, Wesley, The Permanente Medical Group, Union City, California, United States

Group or Team Name

  • GSAA Nephrology
Background


Peritoneal dialysis (PD) is a home based modality that has many benefits. However, it can be challenging for patients with physical disabilities and psychosocial barriers, particularly the elderly. Assisted PD can provide support to overcome these barriers and promote PD utilization and retention. Assisted PD programs have been in use worldwide for over 20 years and have demonstrated good results. There are no such programs in the US. Kaiser Permanente Northern California (KPNC) is an integrated health care system that serves over 4.4 million members. Our PD unit in the Greater Southern Alameda Area is an internal PD program in KPNC, serving over 150 patients. In 2018 a pilot program of assisted PD was developed by the our unit to help overcome common barriers to PD and expand it as modality of choice.

Methods

A seven month pilot of temporary assisted PD was completed from April to October 2018. Patients were identified using certain selection criteria and assisted PD was offered for a time limited period of 90 days per patient. A single PD RN was designated as the assist PD nurse. The assistance included cycler set up and connections; lifting bags; performing CAPD exchanges; adding antibiotics; retraining and psychosocial support.

Results

Sixteen PD patients (7 incident, 9 prevalent) were assisted with a total of 59 visits. Reasons were anxiety/psychosocial (7); ankle fracture (1); frail elderly (4); peritonitis (3) and respite (1). Visits per patient ranged from 1-10. 50% (8) stayed on PD; 13% (2) switched to hemodialysis (HD); 31% (5) expired and 1 relocated.

Conclusion

Assisted PD provides an effective means to support frail or functionally limited PD patients, encouraging them to select it as a modality and/or remain on PD. In our pilot, providing this assistance enabled us retain 50% of our patients on PD, who would otherwise have had to transfer to in center HD. Assisted PD is a valid and safe alternative to in center HD and should be used to expand modality choices, overcome barriers to PD and shift care to home.

Funding

  • Clinical Revenue Support