Targeted intervention to improve compliance in an urban hemodialysis population

Noncompliance impacts the successful delivery of care to the "urban" ESRD population. It is our belief that noncompliance can be an extension of the dysfunctional coping mechanisms of patients who lack adequate psychosocial support. In this article, we have described a pilot program providing on-site, targeted intervention for patients identified at increased risk for poor clinical outcomes, based on failure to comply with the prescribed dialysis treatment prescription. This collaboration between our "nephrology practice," an outpatient "HD facility," and a "C-L psychiatry service" has resulted in extremely low no-show rates in an urban dialysis population. We have also discovered an opportunity for reducing hospitalizations. Targeted intervention can improve compliance and prove to be cost effective.