Responses from Clinical Directors

As part of the campaign to increase the incidence of home dialysis, all 94 Clinical Directors across the country were asked to provide details of their Home Therapies programmes, to detail their plans for the future and to share any examples of good practice. A total of 31 responses were received and of these 23 were from England, two from Northern Ireland, five from Scotland and one from Wales. The information requested was in two main parts –firstly there was the basic data on percentages on home dialysis and the breakdown between PD and HD. Secondly, Clinical Directors were asked to provide more detailed information on their plans to increase the incidence of home dialysis and invited them to share innovation and good practice that might be useful to others.

An analysis of the basic data showed that only 3 respondents did not declare their percentage on home therapies, the remaining 28 varied between 10% and 50%. The 50% related to Alder Hey which, as a children’s hospital, may not be as representative of the generality. After Alder Hey, the next highest percentage of patients on home therapies was Shrewsbury at 30%. The average percentage of patients on home dialysis of those who responded is 18%, or 16% if Alder Hey is taken out of the calculation – this is better than last year, but indicates that there is still considerable scope for improvement.

The information provided on plans for the future and sharing of good practice was considered separately and a number of themes emerged. For Peritoneal Dialysis (PD) there were several initiatives on improved catheter access and the introduction of new techniques for catheter insertion. There were also several examples of centres introducing assisted PD, giving better opportunities for more elderly or frail patients being able to dialyse at home. For HHD there was a drive to introduce more portable machines, with NxStage leading the field, but with significant interest in, and testing of, Quanta and Physidia.

From a more general perspective many centres had well supported programmes to promote home dialysis – several were using KQIP resources and there was a trend to introduce more shared care as a stepping stone to going home. There were a number of initiatives reported aimed at encouraging patients to consider home dialysis seriously, as well as training programmes for staff, often working in Multi-Disciplinary Teams, to ensure their commitment to promoting this therapy. These included face to face events, videos, questionnaires and regular reviews.

There is no doubt from the answers received that, despite the difficulties, there is a great deal of enthusiasm for developing home therapies across the country. The responses make interesting reading and a full tabulation of these can be found from page 28.