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

Survey distributed at 5 international dialysis and nephrology congresses in 2007 Responses from 6595 delegates, 57% physicians, 28% nurses, 15% administrators or other 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  In-centre HD/HDF  Home/self-care HD/HDF 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?” Wat is de beste behandeling? CAPD/APD

Question: “ What do you consider to be the best long-term dialysis treatment for the majority of patients, today and in the near future?”  CAPD/APD  In-centre HD/HDF 3x/week  In-centre HD/HDF > 3x/week  Home/self-care HD/HDF > 3x/week Wat is de beste behandeling?

Question: “ What do you consider to be the best long-term dialysis treatment for the majority of patients, today and in the near future?” Wat is de beste behandeling? Home/self-care HD/HDF

Opinion vs reality (long term treatment) Wat is de beste behandeling?

Gegevens NBVN: verdeling volgens dialysebehandeling

Gegevens van ZNA: verdeling volgens dialysebehandeling

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

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

30 jaar PD in ZNA Gegevens NBVN: instroom dialyse

30 jaar PD in ZNA Gegevens NBVN: co-morbiditeit

Complex en multifactorieel: education of health care provider physician bias reimbursement policies availability patient preference/disinterest Oorzaak enkel leeftijd en co-morbiditeit?

1997 USRDS Morbidity and Mortality Study, Wave 2: only 25% of patients receiving in-center hemodialysis were presented self-care therapies such as PD or HomeHD as initial therapy options 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 Oorzaak enkel leeftijd en co-morbiditeit?

Wellbound, 2007: 576 patients – early education on all available treatment options - 42% selected self-care (home) therapy. 206 patients completed training: 164 (80%) chose PD and 42 (20%) HomeHD Grote nood aan pre-dialyse educatie! Oorzaak enkel leeftijd en co-morbiditeit?

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 Keuze dialysebehandeling

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’ 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 nierfunctievervangende therapie nodig: pre-emptieve transplantatie 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 betrekken in beslissingsproces over ganse loop van de behandeling Integrated Care

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