The Home Network: An Australian National Initiative for Home Therapies

Chow, Josephine; Fortnum, Debbie; Moodie, Jo-Anne; Simmonds, Rosemary; Tomlins, Melinda

doi:10.1111/j.1755-6686.2013.00339.x

Cited by 11 publications

(12 citation statements)

References 5 publications

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“…Home-based dialysis modalities are being increasingly promoted internationally as preferred renal replacement therapy options when transplantation is not immediately feasible. 1 , 2 , 3 , 4 , 5 , 6 Both home peritoneal dialysis (PD) and home hemodialysis (HD) are associated with similar or better survival than in-center HD, 7 while offering better patient autonomy and quality of life, 8 , 9 at lower cost. 10 , 11 PD remains the dominant home dialysis therapy, comprising 15% of dialysis in developed countries.…”

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confidence: 99%

The risk of hospitalization and modality failure with home dialysis

Suri

Nesrallah

2015

Kidney International

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While home dialysis is being promoted, there are few comparative effectiveness studies of home-based modalities to guide patient decisions. To address this, we matched 1116 daily home hemodialysis (DHD) patients by propensity scores to 2784 contemporaneous USRDS patients receiving home peritoneal dialysis (PD), and compared hospitalization rates from cardiovascular, infectious, access-related or bleeding causes (prespecified composite), and modality failure risk. We performed similar analyses for 1187 DHD patients matched to 3173 USRDS patients receiving in-center conventional hemodialysis (CHD). The composite hospitalization rate was significantly lower with DHD than with PD (0.93 vs. 1.35/patient-year, hazard ratio=0.73 (95% CI=0.67–0.79)). DHD patients spent significantly fewer days in hospital than PD patients (5.2 vs. 9.2 days/patient-year), and significantly more DHD patients remained admission-free (52% DHD vs. 32% PD). In contrast, there was no significant difference in hospitalizations between DHD and CHD (DHD vs. CHD: 0.93 vs. 1.10/patient-year, hazard ratio 0.92 (0.85–1.00)). Cardiovascular hospitalizations were lower with DHD than with CHD (0.68 (0.61–0.77)), while infectious and access hospitalizations were higher (1.15 (1.04–1.29) and 1.25 (1.08–1.43), respectively). Significantly more PD than DHD patients switched back to in-center HD (44% vs. 15% 3.4 (2.9–4.0)). In this prevalent cohort, home DHD was associated with fewer admissions and hospital days than PD, and a substantially lower risk of modality failure.

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confidence: 99%

The risk of hospitalization and modality failure with home dialysis

Suri

Nesrallah

2015

Kidney International

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“…The AKTN designs, conducts and supports clinical trials and fosters clinical trials expertise in Australia and New Zealand in conjunction with global collaborators. The HN was established in 2010, as an Australian initiative to bring together healthcare professionals in the field of home dialysis with the aims of identifying and addressing the barriers to optimal utilization of home dialysis in Australia …”

Section: Methodsmentioning

confidence: 99%

“…The HN was established in 2010, as an Australian initiative to bring together healthcare professionals in the field of home dialysis with the aims of identifying and addressing the barriers to optimal utilization of home dialysis in Australia. 13…”

Section: Methodsmentioning

confidence: 99%

Teaching peritoneal dialysis in Australia: An opportunity for improvement

et al. 2018

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Introduction Up to a 10‐fold difference in clinical outcomes between Australian peritoneal dialysis (PD) units exists. There is an international focus on the harmonization of educational practices in PD to determine whether this may lead to improved patient outcomes. Aims The aim of this paper is to evaluate the current teaching practices of nurses and patients in Australian PD units. Methods An online survey with questions on nurse and patient training was made available to PD units in Australia. Results Thirty‐eight (70%) of 54 PD units in Australia completed the survey. A written standardized curricula was utilized in 21 units (55%) for nursing staff and 30 units (79%) for patients, with 23% and 12% including an electronic delivery component for each group, respectively. Universal teaching of adult learning principles was not demonstrated. The hours spent on teaching nursing staff ranged from <15 h in 24% to >100 h in 21% of units. The average number of hours spent by nurses each day to train patients ranged from <2 h in 14% to >6 h in 11% of units, with the average total training days ranging from 2 to 3 days in 14% to over 7 days in 14% of units. Staff and patient competency assessments were performed routinely in 37% and 74% of units, respectively. Conclusions Considerable differences exist amongst Australian PD units in the education of staff and patients. There is a general lack of delivery and competency assessment to meet educational standards. It remains to be seen if harmonization of educational curricula can translate to improved clinical outcomes.

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“…Beyond purely governmental based drivers of change, national programs such as the HOME network advocate for home therapies and are critical to maintain enthusiasm, drive education policy and provide support to both healthcare professionals and patient groups. This initiative, established in 2010 works to provide early patient education, nursing, and physician education as well as maintaining a lobbying taskforce to advocate for ongoing financial support from both government and utility companies.…”

Section: Moving Forward In Home Dialysis: Policy and Perspectivesmentioning

confidence: 99%

DEBATE: Should Dialysis at Home be Mandatory for All Suitable ESRD Patients?

Lewicki

Polkinghorne

Kerr

2014

Seminars in Dialysis

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Since their inception in the 1960s, home-based dialysis therapies have been viable alternatives to conventional thrice weekly in center hemodialysis. In spite of this, uptake of these therapies has been steadily declining over past decades with utilization varying globally; dependent on training support, funding models, and prevailing Nephrologist beliefs. In the Australian context, home dialysis (predominantly peritoneal dialysis and extended hours nocturnal hemodialysis) is now again increasing in popularity--with enthusiasm driven not only by evidence of an array of physiological and psychological patient benefit but also significant economic advantage: critical in the current climate where dialysis therapies in Australia take approximately $1 billion dollars per year from the healthcare budget. When assessing the significant advantages of home-based therapies, it is important to consider not only the increasing body of evidence around improved survival but also that for dramatically better health-related quality of life, decreased economic burden and the overall benefits of undertaking treatment in the home. With patient-centered care an increasingly important aspect of our decision making paradigm, home-based dialysis should be considered as the default option in all patients transitioning to renal replacement therapy.

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The Home Network: An Australian National Initiative for Home Therapies

Cited by 11 publications

References 5 publications

The risk of hospitalization and modality failure with home dialysis

The risk of hospitalization and modality failure with home dialysis

Teaching peritoneal dialysis in Australia: An opportunity for improvement

DEBATE: Should Dialysis at Home be Mandatory for All Suitable ESRD Patients?

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