Background: The model used in the Peritoneal Dialysis (PD) unit at the Royal Hobart Hospital (RHH) is predominately a home-based model, where all education, training, ongoing support and care, including treatment of peritonitis (where appropriate) is undertaken in the home. We contend that training in a patient’s home with intensive follow up support is a safe, cost effective treatment option with improved patient outcomes in comparison to a hospital-based model.
Method: We reviewed results for people under the care of the PD unit between 1/1/07 and 31/7/08 comparing them with another Dialysis Hospital (DH) that uses a more centrally based model of care.
Results: During this time period, RHH had 60 patients, 40 episodes of peritonitis, (20.5/pt month), of which 22.5% required admission to hospital. In comparison, the DH had 27 patients, 13 episodes of peritonitis (36.6/pt month) and 100% admission rate. Total admitted bed days were less than half for RHH (1.3 days/patient) compared with DH (3.7 days/patient). Total training days were DH 52 days(3-4 days per new patient), and for RHH 152 days (3.8 days per new patient). There were no discernable differences between age, gender and diabetes, though the DH had no patients with cancer and RHH had 5 patients. Both RHH and DH had 40% of patients completely well, 24 patients and 11 patients respectively.
Conclusion: With intensive support in the initial stages, and treating patients as much as possible in the home, we believe we have developed a safe and cost effective alternative model of care.