Department of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Public Health Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.
Clin J Am Soc Nephrol. 2022 Apr;17(4):535-545. doi: 10.2215/CJN.13191021. Epub 2022 Mar 21.
Home dialysis therapies (peritoneal and home hemodialysis) are less expensive and provide similar outcomes to in-center hemodialysis, but they are underutilized in most health systems. Given this, we designed a multifaceted intervention to increase the use of home dialysis. In this study, our objective was to evaluate the effect of this intervention on home dialysis use in CKD clinics across Canada.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a cluster randomized controlled trial in 55 CKD clinic clusters in nine provinces in Canada between October 2014 and November 2015. Participants included all adult patients who initiated dialysis in the year following the intervention. We evaluated the implementation of a four-component intervention, which included phone surveys from a knowledge translation broker, a 1-year center-specific audit/feedback on home dialysis use, delivery of an educational package (including tools aimed at both providers and patients), and an academic detailing visit. The primary outcome was the proportion of patients using home dialysis at 180 days after dialysis initiation.
A total of 55 clinics were randomized (27 in the intervention and 28 in the control), with 5312 patients initiating dialysis in the 1-year follow-up period. In the primary analysis, there was no difference in the use of home dialysis at 180 days in the intervention and control clusters (absolute risk difference, 4%; 95% confidence interval, -2% to 10%). Using a difference-in-difference comparison, the use of home dialysis at 180 days was similar before and after implementation of the intervention (difference of 0% in intervention clinics; 95% confidence interval, -2% to 3%; difference of 0.8% in control clinics; 95% confidence interval, -1% to 3%; =0.84).
A multifaceted intervention did not increase the use of home dialysis in adults initiating dialysis.
A Cluster Randomized Trial to Assess the Impact of Patient and Provider Education on Use of Home Dialysis, NCT02202018.
家庭透析疗法（腹膜和家庭血液透析）的费用较低，且与中心血液透析的结果相似，但在大多数卫生系统中的应用不足。有鉴于此，我们设计了一种多方面的干预措施来增加家庭透析的应用。在这项研究中，我们的目标是评估该干预措施对加拿大各地慢性肾脏病（CKD）诊所中家庭透析使用情况的影响。
设计、地点、参与者和测量：我们于 2014 年 10 月至 2015 年 11 月在加拿大 9 个省的 55 个 CKD 诊所集群中进行了一项集群随机对照试验。参与者包括在干预后一年内开始透析的所有成年患者。我们评估了一个由四个部分组成的干预措施的实施情况，该措施包括来自知识转化经纪人的电话调查、针对家庭透析使用情况的为期 1 年的特定中心审计/反馈、提供教育包（包括针对提供者和患者的工具）以及学术详细访问。主要结局是在透析开始后 180 天内使用家庭透析的患者比例。
共有 55 个诊所被随机分组（干预组 27 个，对照组 28 个），在 1 年的随访期间有 5312 名患者开始透析。在主要分析中，干预组和对照组在 180 天时使用家庭透析的情况没有差异（绝对风险差异为 4%；95%置信区间为-2%至 10%）。使用差异差异比较，干预实施前后 180 天使用家庭透析的情况相似（干预组为 0%；95%置信区间为-2%至 3%；对照组为 0.8%；95%置信区间为-1%至 3%；=0.84）。
多方面的干预措施并未增加开始透析的成年人对家庭透析的使用。
评估患者和提供者教育对家庭透析使用影响的一项集群随机试验，NCT02202018。
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