Systematic barriers to the effective delivery of home dialysis in the United States: a report from the Public Policy/Advocacy Committee of the North American Chapter of the International Society for Peritoneal Dialysis.

Golper TA, Saxena AB, Piraino B, Teitelbaum I, Burkart J, Finkelstein FO, Abu-Alfa A
Am J Kidney Dis. 2011 58 (6): 879-85

PMID: 21903316 · DOI:10.1053/j.ajkd.2011.06.028

Home dialysis, currently underused in the United States compared with other industrialized countries, likely will benefit from the newly implemented US prospective payment system. Not only is home dialysis less expensive from the standpoint of pure dialysis costs, but overall health system costs may be decreased by more subtle benefits, such as reduced transportation. However, many systematic barriers exist to the successful delivery of home dialysis. We organized these barriers into the categories of educational barriers (patient and providers), governmental/regulatory barriers (state and federal), and barriers specifically related to the philosophies and business practices of dialysis providers (eg, staffing, pharmacies, supplies, space, continuous quality improvement practices, and independence). All stakeholders share the goal of delivering home dialysis therapies in the most cost- and clinically effective and least problematic manner. Identification and recognition of such barriers is the first step. In addition, we have suggested action plans to stimulate the kidney community to find even better solutions so that collectively we may overcome these barriers.

Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

MeSH Terms (12)

Accreditation Health Services Accessibility Hemodialysis, Home Humans Kidney Failure, Chronic Medicare Nephrology Patient Education as Topic Peritoneal Dialysis Prospective Payment System Total Quality Management United States

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