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Kiezen voor low cost dialyse:

Survey results from 5 international nephrology congresses in 2007 regarding initial and long-term dialysis treatments, highlighting underutilization of home dialysis, emphasizing on cost-effectiveness and quality of life improvement.

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Kiezen voor low cost dialyse:

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  1. peritoneale dialyse, thuisdialyse, nacht- of low care dialyse? Kiezen voor low cost dialyse: Dr. Heidi Hoeben Dr. Ilse Muyshondt

  2. Wat is de beste behandeling? Survey distributed at 5 international dialysis and nephrology congresses in 2007 Responses from 6595 delegates, 57% physicians, 28% nurses, 15% administrators or other

  3. Wat is de beste behandeling? Question: “ What do youconsider the best initialdialysis treatment for a patientwithplanned start, todayand in the nearfuture?” CAPD/APD In-centre HD/HDF Home/self-care HD/HDF

  4. Wat is de beste behandeling? Question: “ What do you consider the best initial dialysis treatment for a patient with planned start, today and in the near future?” CAPD/APD

  5. Wat is de beste behandeling? Question: “ What do youconsidertobe the best long-term dialysis treatment for the majority of patients, todayand in the nearfuture?” CAPD/APD In-centre HD/HDF 3x/week In-centre HD/HDF > 3x/week Home/self-care HD/HDF > 3x/week

  6. Wat is de beste behandeling? Question: “ What do youconsidertobe the best long-term dialysis treatment for the majority of patients, todayand in the nearfuture?” Home/self-care HD/HDF

  7. Wat is de beste behandeling? Opinion vsreality (long term treatment)

  8. Gegevens NBVN: verdeling volgens dialysebehandeling

  9. Gegevens van ZNA: verdeling volgens dialysebehandeling

  10. WHY??? Underutilisation! Kosteneffectiviteit Levenskwaliteit vitaliteit verbeterde eetlust minder slaapproblemen verbeterde sexualiteit grotere onafhankelijkheid flexibiliteit meer betrokkenheid bij en controle over behandeling meer tewerkstelling

  11. Gegevens NBVN: prevalentie, verdeling volgens leeftijdscategorie 30 jaar PD in ZNA

  12. Gegevens NBVN: instroom dialyse 30 jaar PD in ZNA

  13. Gegevens NBVN: co-morbiditeit 30 jaar PD in ZNA

  14. Oorzaak enkel leeftijd en co-morbiditeit? Complex en multifactorieel: education of health care provider physician bias reimbursementpolicies availability patientpreference/disinterest

  15. Oorzaak enkel leeftijd en co-morbiditeit? 1997 USRDS MorbidityandMortalityStudy, Wave 2: only 25% of patientsreceiving in-center hemodialysiswerepresentedself-care therapiessuch as PD or HomeHD as initialtherapy options

  16. Oorzaak enkel leeftijd en co-morbiditeit? Attitudes of Canadian nephrologists toward dialysis modality selection, Jung et al. PDI 1999: only 18% of new patients with ESRD had medical contraindications against starting PD at home

  17. Oorzaak enkel leeftijd en co-morbiditeit? Wellbound, 2007: 576 patients – earlyeducation on allavailable treatment options - 42% selectedself-care (home) therapy. 206 patientscompleted training: 164 (80%) chose PD and 42 (20%) HomeHD Grote nood aan pre-dialyse educatie!

  18. Keuze dialysebehandeling The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies, Morton et al. BMJ 2010 – review of qualitative studies of decision making and choice for dialysis, transplantation, or palliative care

  19. Integrated Care Definitie(Wikipedia): ‘also known as coordinated care, comprehensive care, seamless care and transmural care – is a worldwide trend in health care reforms and new organizational arrangements focusing on more coordinated and integrated forms of care provision. Integrated care may be seen as a response to the fragmented delivery of health and social services being an acknowledged problem in many health systems’

  20. Integrated Care Patiënt centraal Tijdige verwijzing naar nefroloog: vroegtijdig aanpakken van cardiovasculaire risicofactoren en co-morbiditeit, met het oog op vertragen van evolutie naar eindstadium nierfalen Als nierfunctievervangendetherapie nodig: pre-emptievetransplantatie met levende donor? Patiënt uitgebreid informeren over voor- en nadelen van de verschillende dialyseopties. Keuze laten tussen home-based en in-center behandeling. Patiënt nauw betrekkenin beslissingsproces over ganse loop van de behandeling

  21. Zijn er nog vragen? Bedankt voor uw aandacht!

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