Abstract: TH-OR70
Comparing Care Models in Assisted Peritoneal Dialysis: Insights from the Alberta Experience
Session Information
- Home Dialysis Hodgepodge: Novel Mechanisms, Solutions, Technologies, and Ideas
October 24, 2024 | Location: Room 8, Convention Center
Abstract Time: 05:30 PM - 05:40 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Hammer, Veronica, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Munawar, Warda, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Lee, Chel, University of Calgary, Calgary, Alberta, Canada
- Fox, Danielle E., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Quinn, Robert R., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Ward, David, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- MacRae, Jennifer M., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
Background
Assisted peritoneal dialysis (aPD) provides home-based support by trained healthcare professionals for individuals otherwise ineligible for independent peritoneal dialysis (PD). Alberta Kidney Care South (AKC-S) initiated an aPD program in 2011, initially led by licensed nursing practitioners (LPNs) until transitioning to healthcare aides (HCAs) in July 2018. Our objective was to assess outcomes of participants in the aPD program based on the care delivery model (LPN vs. HCA).
Methods
This quantitative study utilized an interrupted time-series model to analyze participants in the AKC-S aPD program from its inception in 2011 until December 31, 2021. Deidentified data was extracted from the Nephrology electronic database. Participants were categorized into two phases based on the implementation of the care delivery model change from LPN to HCA on July 1, 2018. Phase one comprised participants who initiated aPD before this date, while phase two included those who began aPD after. The primary outcome was monthly median exit time from PD between the two care groups. Endpoints were defined as death, transplant, transfer to in-center HD, transfer to independent PD, or exit from the program. Secondary outcomes included reason for program exit and rates of peritonitis compared between the two phases.
Results
A total of 135 patients received aPD (mean age= 70.7 ± 11.2 years; 44.4% female). We had 57 individuals in phase one, and 55 in phase two (23 still active participants were excluded), with no difference in sex between groups (p = 0.055). We found no difference in the time spent on PD between the LPN phase (1.89 [1.02, 3.85] years) and the HCA phase (1.41 [0.59, 3.25]), p= 0.41. There was no significant difference in the reason for exit after the change in care model (p= 0.64). The incidence rate of peritonitis in phase one was 0.403 (25 participants) and 0.466 (29 participants) in phase two, which was not statistically significant, p = 0.60.
Conclusion
Our study revealed no significant difference in the duration of peritoneal dialysis (PD), reasons for program exit, or incidence of peritonitis between the LPN and HCA care models. The HCA model offers a cost-effective alternative to in-center modalities while offering personalized, in-person services that may greatly enhance the quality of care for those undergoing peritoneal dialysis.