EXTON, Pa.—Lack of patient interest is the biggest barrier to home dialysis, but the new bundling payment system could increase the use of home modalities, according to the latest research released April 21 from BioTrends Research Group.
The majority of medical directors and dialysis nurses surveyed by BioTrends expect their use of peritoneal dialysis and home hemodialysis to increase in the near future, although the increase is likely to favor one modality over another. This change is mainly financially driven in light of bundling, although in line with best clinical practice according to a rank order completed by medical directors regarding perceptions of modality choice on patient outcomes.
The report is based on responses to an online survey completed by 78 dialysis center medical directors and 34 dialysis nurses. Qualitative interviews were also conducted with three PD and three home hemodialysis thought leaders.
Currently, the vast majority of patients receiving dialysis in the United States are on in-center hemodialysis. Medical directors recognize that alternative modalities are under-utilized and report that patient preference is the largest influencer in modality choice, according to the survey. Consequently, medical directors view lack of patient interest as the largest barrier to increased use of home modalities.
Thought leaders in this area tend to feel that if nephrologists were more comfortable with these modalities, patients would be better educated about the options, and there would be an increased use of home modalities, according to the survey. While there are a number of co-morbidities that encourage or discourage use, and certain patients who are not appropriate for home therapies, thought leaders feel that a significant number of patients who currently receive in-center hemodialysis are candidates for home therapies.
Interestingly, despite the fact that the vast majority of U.S. dialysis patients are currently treated with in-center hemodialysis, 98 percent of the medical directors surveyed would choose a home modality for themselves if they needed dialysis, according to the report.
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