Shared care, home haemodialysis and the expert patient

The key emphasis for health care is to increase patient choice whilst improving effectiveness. Our Haemodialysis Unit in the UK improved standards and patient choice by introducing a 'shared-care' programme-a programme that enabled our patients to manage their own care with nursing support.

The main aims of the programme were to increase efficiency by reviewing home haemodialysis (HHD) processes, reduce waiting times (mean six months), increase patient choice and implement a self-management programme which could be adapted for any patient.

A training package was developed using audit results and consultation with patients. All aspects of renal failure and dialysis were included and a training aid was developed to support the package.

Forty-eight percent (69/145) of patients in the unit expressed an interest in taking part in shared care. Thirty-five patients were involved in the pilot, 7 have transferred to HHD, 18 wish to remain in the unit. After training, all patients were able to choose more convenient haemodialysis times. The waiting time for HHD reduced to 10-12 weeks following a seamless transfer from shared care.