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A Service Reconfiguration Bundle for Expanding Access to Peritoneal Dialysis Including for Older Frailer Patients
Michael Corr1,2, Carolyn Hunter3, Daniel Conroy4
1Centre of Public Health, Queen's University Belfast, Belfast BT7 1NN, UK.
Healthcare (Basel, Switzerland)
|June 10, 2023
Summary
A service reconfiguration bundle successfully doubled peritoneal dialysis (PD) patient numbers in Northern Ireland. This flexible approach expanded access to home-based dialysis, improving patient outcomes and cost-effectiveness.
Area of Science:
- Nephrology
- Surgical Services
- Healthcare Management
Background:
- Peritoneal dialysis (PD) rates were historically low in Northern Ireland.
- PD is a cost-effective alternative to haemodialysis for end-stage kidney disease.
- International goals emphasize increasing home-based dialysis options.
Purpose of the Study:
- To evaluate the impact of a service reconfiguration bundle on PD access in Northern Ireland.
- To demonstrate how service changes can expand PD utilization.
- To align with national strategies for home dialysis therapies.
Main Methods:
- Implemented a service bundle including surgical and radiology leads for PD catheter insertion.
- Established nephrology-led ultrasound-guided PD catheter insertion services.
- Prospectively followed all PD catheter insertions over one year, collecting demographic, procedural, and outcome data.
Main Results:
- Annual PD catheter insertions doubled, reaching 66 patients.
- Multiple insertion techniques (laparoscopic, percutaneous, open) accommodated diverse patient needs.
- 97% of patients successfully initiated PD, with 48% of elective insertions occurring in decentralized hubs.
Conclusions:
- A bundled service reconfiguration effectively doubled the incident PD population.
- Flexible service delivery models can rapidly enhance access to PD.
- This approach supports the expansion of home dialysis therapies.
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