J LEE1, E TAN1,
1Waikato Hospital, Hamilton, New Zealand
Aim: To compare Assisted Self-Care Haemodialysis (ASCHD) with In-Centre Haemodialysis (ICHD)
Background: The huge increase in local haemodialysis (from 12543 to 16113 sessions for 2010 and 2015 respectively) threatens capacity. Our unit’s ‘home-dialysis first’ policy (being patient-centric and cost-effective) isn’t suitable for all. ASCHD however, facilitates independent patient self-dialysis in hospital facilities; regardless of home circumstances. The nurse/patient ratio (1:5) is lower than for ICHD (1:3).
Methods: Data was retrospectively collected for a week (27/3/2017-1/4/2017) on patient demographics (age, diabetes status, gender, ethnicity and clearances) and nursing/patient ratios. Existing ICHD patients were evaluated to identify potential candidates suitable for ASCHD. T-test and Chi-squared were used for statistical analysis.
Results:28 ASCHD and 92 ICHD patients (using 78 and 251 dialysis slots respectively, with non-attendances causing discrepancies) were analysed. Results (ASCHD versus ICHD): mean age (47.64±2.40years versus 59.60±1.43years, p<0.001), diabetic (50.0% versus 52.2%), male/female ratio (60.7%:39.3% versus 62.0%:38.0%), ethnicity (Maori 75.0% versus 54.3% p=0.05; European/Others 21.4%/3.6% versus 28.3%/17.4%), urea reduction ratio (69.75±1.44% versus 70.37±0.88%) and nurse/patient ratio (1:4.33 versus 1:3.26, representing 1 full-time nurse savings per 13.2 ICHD patients). 42 ICHD patients (45.6%) were potentially suitable for ASCHD.
Conclusions: ASCHD is more staff-efficient but still better staffed than planned (vice versa for ICHD). ASCHD patients were significantly younger (by 12.0 years average) with greater Maori proportion. ASCHD numbers could be further increased by converting more (up to 45.6%) ICHD patients.
Discussion: ASCHD’s high requirements (patients must perform >80% dialysis independently) may self-select younger patients. Social factors preventing some independent patients from fully home-dialysing may account for higher Maori proportion on ASCHD. Converting more ICHD patients to ASCHD could allow more patients to benefit and is cost-effective.