Breaking Through Barriers with Home Hemodialysis (HHD) Group Training, Enhancing Access and Improving Patient Experience: A Single-Center Experience
- Managing the Many Facets of Home Dialysis
November 03, 2023 | Location: Room 120, Pennsylvania Convention Center
Abstract Time: 04:39 PM - 04:48 PM
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
- Bermudez, Maria, Geisinger Medical Center, Danville, Pennsylvania, United States
- Zafar, Waleed, Geisinger Medical Center, Danville, Pennsylvania, United States
Despite emerging evidence supporting greater quality of life (1) and improved cardiovascular outcomes (2, 3), HHD remains underutilized in the U.S. (4) Two barriers to widespread adoption are delayed access to HHD due to a shortage of HHD units and staff; and patient apprehension about taking dialysis in their own hands. Group training for HHD remains underutilized in the US with less than 5% of units implementing this training strategy. Given lack of experience, little is known about group training in HHD. We describe a single center experience of instituting group training for HHD.
All patients and their care-partners currently enrolled in HHD program who underwent group training were surveyed. We evaluated the impact of group training on duration of training, unit census growth, need for retraining, incidence of complications and patient experience.
A total 6 consecutive groups of 2 and 3 patients at a time for a total of 16 patients were trained in HHD over a period of 7 months. Training time averaged 30-40 days and was similar for all groups and comparable to solo training. Unit census tripled during this period going from 7 patients to 23. Demographic characteristics are described in table 1. 14 (87.5%) patients had no missed treatments over a 3 month period and no patient needed retraining over the follow up period. 1 patient transitioned to in-center dialysis and 1 died. All patients who were surveryed agreed that group training was an enjoyable experience and strongly recommended to others.
In our experience, group training has proven to be an effective strategy for scaling HHD training. It has helped overcome two major barriers to HHD: prompt access to training and patients' need for strong support in the early training phase. Ongoing longitudinal data collection will help us evaluate association of group HHD training with outcomes including missed treatments, need for retraining and respite care, and patient quality of life scores. Group training has the potential to be an empowering tool for our patients and to enhance our ability to cross train nurses in HHD thus potentially helping with nursing attrition.