Smith M D, Hong B A, Province M A, Robson A M
Am J Kidney Dis. 1985 Jan;5(1):27-31. doi: 10.1016/s0272-6386(85)80131-1.
The availability of an adequate system of social support has been suggested to be significant in determining whether an end-stage renal disease (ESRD) patient is dialyzed in a center or at home. To evaluate this hypothesis more completely, we conducted a study of social support among 257 home and center hemodialysis patients receiving maintenance therapy at four facilities in a midwestern, metropolitan area. A statistically significant difference, chi 2(3) = 14.031, P = 0.0029, was observed in the percentage of patients with social support available to them across the four facilities. The distribution of patients between home and center hemodialysis at the facilities also differed significantly, chi 2(3) = 14.919, P = 0.0019. An adequate social support system was present among 96.4% of the 55 home hemodialysis patients and 85.6% of the 202 center hemodialysis patients, a difference that was statistically significant, chi 2(1) = 4.684, P = 0.0305. However, a more detailed analysis of these findings revealed that the presence of social support was not significant, chi 2(1) = 1.080, P = 0.2995, in determining whether and ESRD patient was dialyzed at home or in a center after accounting for the facility differences. The facility differences remained significant in determining the setting of hemodialysis even after correcting for social support, chi 2(3) = 10.740, P = 0.0132. We concluded, therefore, that the attitudes of clinical staff toward home and center hemodialysis and the willingness of staff to develop those resources that facilitate a specific treatment setting are the principal elements in the therapy selection process.
社会支持系统是否完善，被认为是决定终末期肾病（ESRD）患者是在透析中心接受透析还是在家中接受透析的关键因素。为了更全面地评估这一假设，我们对中西部一个大都市地区四家医疗机构中接受维持性治疗的257名家庭血液透析和中心血液透析患者的社会支持情况进行了研究。在这四家医疗机构中，能获得社会支持的患者比例存在显著的统计学差异，卡方值χ2(3)=14.031，P=0.0029。各医疗机构中家庭血液透析患者和中心血液透析患者的分布也存在显著差异，卡方值χ2(3)=14.919，P=0.0019。在55名家庭血液透析患者中，96.4%的患者拥有完善的社会支持系统；在202名中心血液透析患者中，这一比例为85.6%，二者差异具有统计学意义，卡方值χ2(1)=4.684，P=0.0305。然而，对这些结果进行更详细的分析后发现，在考虑到医疗机构差异后，社会支持的存在与否对于决定ESRD患者是在家中还是在透析中心接受透析并无显著影响，卡方值χ2(1)=1.080，P=0.2995。即使在对社会支持进行校正后，医疗机构差异在决定血液透析地点方面仍然具有显著意义，卡方值χ2(3)=10.740，P=0.0132。因此，我们得出结论，临床工作人员对家庭血液透析和中心血液透析的态度以及工作人员开发有助于特定治疗环境的资源的意愿是治疗选择过程中的主要因素。
