Diebel Lucas, Jafari Maryam, Shah Sachin, Day Christine, McNaught Connie, Prasad Bhanu
College of Medicine, University of Saskatchewan, Regina, Canada.
Dr. T. Bhanu Prasad Medical Professional Corporation, Regina, SK, Canada.
Can J Kidney Health Dis. 2020 Aug 10;7:2054358120948293. doi: 10.1177/2054358120948293. eCollection 2020.
Despite clinical and lifestyle advantages of home hemodialysis (HHD) compared with in-center hemodialysis (ICHD), it remains underutilized in our province. The aim of the study was to explore the patients' perception and to identify the barriers to use of HHD in Saskatchewan, Canada.
The primary objective of the study was to evaluate and explore patient perceptions of HHD and to identify the obstacles for adoption of HHD in Saskatchewan. The secondary objective was to examine variations in the patients' perceptions and barriers to HHD by center (main dialysis units vs satellite dialysis units).
This is a cross-sectional observational survey study.
Two major centers (Regina and Saskatoon) and 5 associated satellite units attached to each center across the province of Saskatchewan.
We approached all prevalent ICHD patients across Saskatchewan, 398 agreed to participate in the study.
Self-reported barriers to HHD were assessed using a questionnaire.
A questionnaire was designed to determine the patients' perceived barriers to HHD. Descriptive statistics was used to present the data. Chi-square and Mann-Whitney test were used to compare the patients' responses between main and satellite units.
Satisfaction with current dialysis care (91%), increase in utility bills (65%), fear of catastrophic events at home (59%), medicalization of one's home (54%), and knowledge deficits toward treatment modalities (54%) were the main barriers to HHD uptake. Compared with patients dialyzing in our main units, satellite patients chose not to pursue HHD more frequently because they had greater satisfaction with their current dialysis unit care (97% vs 87%, < .001), felt more comfortable dialyzing under the supervision of medical staff (95% vs 86%, < .007), could not afford additional utility costs (92% vs 45%, < .001), were unaware of the risks and benefits of HHD (83% vs 33%, < .001), had concerns over time commitments for training to HHD (69% vs 32%, < .001), and had concern for family burnout (60.8% vs 40.6%, < .001).
We used questionnaires to quantify known barriers, and this prevents inclusion of additional barriers that individual patients may consider important. Cross-sectional data can only be used as a snapshot. Only 398 patients agreed to participate, and the results cannot be generalized to 740 prevalent HD patients. We did not capture data on demographics (age, income, and literacy level), comorbidities, and dialysis vintage, which would have been helpful in interpretation of the results.
Satisfaction with in-center care, lack of awareness and education, specifically in the satellite population, concerns with family burnout, expenses associated with utilities, and training time will need to be addressed to increase the uptake of HHD.
The study was not registered on a publicly accessible registry as it did not involve any health care intervention on human participants.
尽管家庭血液透析（HHD）相较于中心血液透析（ICHD）具有临床和生活方式上的优势，但在我省其使用率仍然较低。本研究的目的是探讨患者的看法，并确定加拿大萨斯喀彻温省使用HHD的障碍。
本研究的主要目的是评估和探讨患者对HHD的看法，并确定萨斯喀彻温省采用HHD的障碍。次要目的是按中心（主要透析单元与卫星透析单元）检查患者对HHD的看法和障碍的差异。
这是一项横断面观察性调查研究。
萨斯喀彻温省的两个主要中心（里贾纳和萨斯卡通）以及每个中心附属的5个相关卫星单元。
我们联系了萨斯喀彻温省所有现有的ICHD患者，398人同意参与研究。
使用问卷评估自我报告的HHD障碍。
设计了一份问卷以确定患者对HHD的感知障碍。使用描述性统计来呈现数据。卡方检验和曼-惠特尼检验用于比较主要单元和卫星单元之间患者的回答。
对当前透析护理的满意度（91%）、水电费增加（65%）、对家中灾难性事件的恐惧（59%）、家庭医疗化（54%）以及对治疗方式的知识欠缺（54%）是采用HHD的主要障碍。与在我们主要单元进行透析的患者相比，卫星单元的患者选择不更频繁地采用HHD是因为他们对当前透析单元护理的满意度更高（97%对87%，P<0.001），在医护人员监督下透析感觉更舒适（95%对86%，P<0.007），负担不起额外的水电费（92%对45%，P<0.001），不了解HHD的风险和益处（83%对33%，P<0.001），担心HHD培训所需的时间投入（69%对32%，P<0.001），以及担心家庭倦怠（60.8%对40.6%，P<0.001）。
我们使用问卷来量化已知障碍，这使得无法纳入个别患者可能认为重要的其他障碍。横断面数据只能用作一个快照。只有398名患者同意参与，结果不能推广到740名现有的血液透析患者。我们没有收集关于人口统计学（年龄、收入和识字水平）、合并症和透析时间的数据，而这些数据将有助于解释结果。
为了提高HHD的采用率，需要解决对中心护理的满意度、缺乏认识和教育（特别是在卫星单元人群中）、对家庭倦怠的担忧、水电费相关费用以及培训时间等问题。
该研究未在公开可访问的注册机构注册，因为它不涉及对人类参与者的任何医疗保健干预。
