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Abstract: FR-PO516

Identifying Major Barriers to Home Dialysis (The IM-HOME Study): Findings From a National Survey of Patients and Providers

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Reddy, Yuvaram N.V., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Kearney, Matthew D., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Ward, Michaela, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Burke, Robert, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Reese, Peter P., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Lane-Fall, Meghan B., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
Background

Increasing home dialysis use from 13% towards 80% of patients with kidney failure by 2025—a goal of the Advancing American Kidney Health initiative—requires a comprehensive understanding of home dialysis barriers. In this national survey, we sought to identify major home dialysis barriers from the perspective of patients and providers to inform strategies to improve home dialysis use.

Methods

We identified major home dialysis barriers using the modified Delphi method—a technique that iteratively leverages stakeholder feedback in multiple stages to reach consensus. First, each of the 7 members of our advisory board of patients and providers listed major barriers to home dialysis. The advisory board then met as a group to discuss these barriers and compile a final list of 12 patient-perceived and 9 provider-perceived barriers. This final list of barriers was distributed as a survey to patients and providers across the US. The survey was informed by the Systems Engineering Initiative for Patient Safety 3.0 conceptual model. Participants ranked their top 3 home dialysis barriers from the list included in the survey. We aggregated participants’ scores to identify the top 3 patient-perceived and top 3 provider-perceived barriers to home dialysis.

Results

There were 522 complete responses: 223 providers and 289 patients (response rates, 11.2% and 1.9%). Patients perceived their top 3 barriers as fear of dialysis, lack of space, and the need for home-based support – all of which occur at home. Providers perceived their top 3 barriers as poor patient education, lack of reimbursable mechanisms to provide additional support, and the need for experienced staff – all of which occur in the clinic.

Conclusion

While patients perceived major barriers at home, providers perceived major barriers in the clinic. These findings highlight the need for novel strategies, such as assisted dialysis, that can simultaneously overcome barriers at home and in the clinic.

Funding

  • Other NIH Support