Hi, and welcome to Home Dialysis Central!
First, we require a partner, and several otherwise excellent candidates just don’t have one.
A couple of thoughts here. First, is there any play in that requirement for a partner? I think it’s a good idea to have someone on hand when blood is outside the body, but some programs have not been requiring partners, and we haven’t heard of any problems. Also, some people who need partners get creative–they let someone stay in an extra room in their home in exchange for being a partner. If you have several patients who are otherwise good candidates without partners, they might consider pairing up, sharing an apartment, and being each other’s partners. Some outside the box thinking may help.
Second, our marketing is terrible: most of the sixty nephrologists in this city don’t look at their patients and realize than I can fix half their problems.
Back when Baxter used to have lots of patient educators in the field (they may still have a few), it took time for those nurses to get the word out to the local nephrologists and to build relationships with them such that they’d get referrals for education. This doesn’t tend to happen instantly. That said, you need to do some marketing! Do you have a budget at all? Home Dialysis Central postcard handouts are free–paper the centers with them. Include them in a direct mailing to the local nephrologists with an announcement about your new program. (Remind them that keeping working-age patients working and insured helps the centers’ bottom line and is better for the patients). Consider offering a lunchtime informational seminar with a Q&A session.
Third, there seems to be no patient modality education done around here. 80% of the patients I approach have never heard of nocturnal dialysis.
To me, this is the #1 reason nationally why people don’t choose a home treatment–they don’t know these options exist. Schreiber et al found that when patients were educated about all modalities, close to half chose PD (vs. the 8% national figure). Both the DMMS Wave 2 study and a more recent study done in ESRD Network 18 found that the vast majority of in-center hemo patients have never heard of PD, home hemo–or even transplant.
So, we built Home Dialysis Central and if you put the word “dialysis” into Google, this site comes up as one of the first listings. It’s next to impossible for patients and family members who go on-line to not know that there are home options now. But…not everyone goes on-line. The postcard handouts are a way to push folks to the website so they can learn more. We also have a number of short, referenced, easy-to-read articles that can be used as educational handouts. You can find the whole series (one a month) at: http://www.homedialysis.org/v1/news/#tom. You may want to do educational seminars for patients as well as nephrologists.
From what we’ve heard from folks in our message boards, certain messages are more helpful than others. Focusing on the need for training, home modifications, and a partner is not especially motivating–those are details that can be shared after someone’s initial interest is hooked in. What does seem to be useful is messages about:
• The ability to keep/regain control of your life (and keep a job if you have one)
• How much better you’re likely to feel without the ups-and-downs of three times a week treatment
• Less restricted diet and fluids and fewer drugs
The experts in our “Consultant’s Corner” may have additional ideas for you. They’ve each agreed to answer one question for free (then you’d be expected to work with them on a fee basis), so why not take advantage of their knowledge?http://www.homedialysis.org/v1/start-a-program/#Consultants