Does social support determine the treatment setting for hemodialysis patients?

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.