♦ BACKGROUND: Peritoneal dialysis (PD) is challenging for patients with functional limitations, and assisted PD can support these patients, but previous reports of assisted PD have not examined the role of temporary assisted PD and had difficulty identifying adequate comparator cohorts. ♦ METHODS: Peritoneal Dialysis Assist (PDA), a 12-month pilot of long-term and temporary assisted PD was completed in multiple PD centers in British Columbia, Canada. Continuous cycler PD (CCPD) patients were identified for PDA by standardized criteria, and service could be long-term or temporary/respite. The PDA program provided daily assistance with cycler dismantle and setup, but patients remained responsible for cycler connections and treatment decisions. Outcomes were compared against both the general CCPD population and patients who met PDA criteria but were not enrolled (PDA-eligible). ♦ RESULTS: Fifty-three PDA patients had an 88% 1-year death- and transplant-censored technique survival that was similar to the general CCPD cohort (84%) and PDA-eligible cohort (86%). The PDA cohort had lower peritonitis rates (0.18 episodes/patient-year vs 0.22 and 0.36, respectively), but higher hospitalization (55% vs 34% and 35%, respectively). Long-term PDA cost approximately CDN$15,000/year in addition to existing dialysis costs. A total of 8/11 respite PDA patients (73%) returned to self-care PD after a median PDA use of 29 days, which costs $1,250/patient. ♦ CONCLUSIONS: Peritoneal Dialysis Assist provides effective support to functionally-limited CCPD patients and yields acceptable clinical outcomes. The program costs less than transfer to HD or long-term care, which represents cost minimization for failing self-care PD patients. Respite PDA provides effective temporary support; most patients returned to self-care PD and service was cost-effective compared with alternatives of hospitalization or transfer to HD.

No abstract

Using a nurse-driven protocol in practice supports the independent nursing role while contributing to safe patient outcomes.

Rationale, aims and objectives: Assisted peritoneal dialysis (PD) is a proven intervention to support patients with functional limitations in performing home-based PD. Previous research has focused on clinical outcomes, but experiences with assisted PD have not been explored from the perspective of patients and providers. Through a 12-month pilot program called PD Assist (PDA), this study elicited these perspectives to improve the program. Methods: A 12-month pilot of PDA delivered by a contracted health service provider delivered across multiple PD units in British Columbia, Canada, was evaluated. A multi-source evaluation model was used, including the semi-structured qualitative feedback in this report. Patients and their families, PD staff and caregiver stakeholders involved in the PDA pilot project, participated in the feedback process. Qualitative feedback was codified and analyzed via a thematic approach to identify values, enablers, barriers and suggestions for PDA program improvement from the perspective of patients andproviders involved in PDA.Results: All stakeholder groups advocated for continuation of PDA services. Key reported values were patient independence, enhanced psychosocial support and relief of treatment-associated burden. Consistency and communication between involved parties were reported as enablers of success, while scheduling conflicts, geographic challenges and staffing inconsistency were viewed as barriers. Areas for program improvement included the need for more personalized services. Conclusions: Semi-structured qualitative feedback provided meaningful insights into the experiences of PDA among patients and providers that were an instrumental part of a successful pilot project and identified opportunities for further program improvement.