一个用于扩大腹膜透析可及性的服务重新配置包，包括为体弱的老年患者提供服务。
A Service Reconfiguration Bundle for Expanding Access to Peritoneal Dialysis Including for Older Frailer Patients.
作者信息
Corr Michael, Hunter Carolyn, Conroy Daniel, McGrogan Damian, Fogarty Damian, O'Neill Stephen
机构信息
Centre of Public Health, Queen's University Belfast, Belfast BT7 1NN, UK.
Regional Nephrology & Transplant Unit, Belfast Health and Social Care Trust, Belfast BT9 7ER, UK.
出版信息
Healthcare (Basel). 2023 Jun 5;11(11):1654. doi: 10.3390/healthcare11111654.
INTRODUCTION
Rates of peritoneal dialysis (PD) have been traditionally low in Northern Ireland. With rising numbers of patients reaching end-stage kidney disease, PD is a more cost-effective treatment than haemodialysis and aligns with international goals to increase home-based dialysis options. The aim of our study was to highlight how a service reconfiguration bundle expanded access to PD in Northern Ireland.
METHODS
The service reconfiguration bundle consisted of the appointment of a surgical lead, a dedicated interventional radiologist for fluoroscopically guided PD catheter insertion, and a nephrology-led ultrasound-guided PD catheter insertion service in an area of particular need. All patients in Northern Ireland who had a PD catheter inserted in the year following service reconfigurations were included and prospectively followed up for one-year. Patient demographics, PD catheter insertion technique, setting of procedure, and outcome data were summarised.
RESULTS
The number of patients receiving PD catheter insertion doubled to 66 in the year following service reconfigurations. The range of approaches to PD catheter insertion (laparoscopic = 41, percutaneous = 24 and open = 1) allowed a wide range of patients to benefit from PD. Six patients had emergency PD catheter insertion, with four receiving urgent or early start PD. Nearly half (48%, 29/60) of the PD catheters inserted electively were in smaller elective hubs rather than the regional unit. A total of 97% of patients successfully started PD. Patients who experienced percutaneous PD catheter insertion were older [median age 76 (range 37-88) vs. 56 (range 18-84), < 0.0001] and had less previous abdominal surgery than patients who experienced laparoscopic PD catheter insertion (25%, 6/24 vs. 54%, 22/41, = 0.05).
DISCUSSION
Through a service reconfiguration bundle, we were able to double our annual incident PD population. This study highlights how flexible models of service delivery introduced as a bundle can quickly deliver expanded access to PD and home therapy.
引言
在北爱尔兰，传统上腹膜透析（PD）的使用率较低。随着终末期肾病患者数量的增加，腹膜透析是一种比血液透析更具成本效益的治疗方法，并且符合增加家庭透析选择的国际目标。我们研究的目的是强调一项服务重新配置方案如何扩大了北爱尔兰腹膜透析的可及性。
方法
服务重新配置方案包括任命一名外科负责人、一名专门负责在荧光镜引导下插入腹膜透析导管的介入放射科医生，以及在一个特别需要的地区开展由肾脏病学主导的超声引导下腹膜透析导管插入服务。纳入了北爱尔兰在服务重新配置后的一年中插入腹膜透析导管的所有患者，并对其进行了为期一年的前瞻性随访。总结了患者的人口统计学特征、腹膜透析导管插入技术、手术地点和结果数据。
结果
在服务重新配置后的一年中，接受腹膜透析导管插入的患者数量翻了一番，达到66例。腹膜透析导管插入方法的范围（腹腔镜插入 = 41例，经皮插入 = 24例，开放手术插入 = 1例）使广泛的患者能够从腹膜透析中受益。6例患者进行了紧急腹膜透析导管插入，其中4例接受了紧急或早期开始的腹膜透析。将近一半（48%，29/60）的选择性插入的腹膜透析导管是在较小的选择性中心而非区域单位。共有97%的患者成功开始了腹膜透析。与接受腹腔镜腹膜透析导管插入的患者相比，接受经皮腹膜透析导管插入的患者年龄更大[中位年龄76岁（范围37 - 88岁）对56岁（范围18 - 84岁），P < 0.000），并且既往腹部手术史更少（25%，6/24对54%，22/41，P = 0.05）。
讨论
通过一项服务重新配置方案，我们能够使每年新接受腹膜透析的患者数量翻倍。本研究强调了作为一个整体引入的灵活服务提供模式如何能够迅速扩大腹膜透析和家庭治疗的可及性。
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