Why aren't NHHD patients knocking down my door?

[ndfay1]

Hi!
I’m a new nocturnal home hemodialysis training nurse working for a small program in a very large company. When I arrived, we had five patients running at night, and in 5 months, I have added one. I am amazed to find that I actually have to solicit (beg) for patients!
I have been very aggressive in obtaining and pursuing leads, harassing doctors, and making a general annoyance of myself. I find myself–instead of training patients–wondering why there aren’t any!
I’ve noted a couple of problems: First, we require a partner, and several otherwise excellent candidates just don’t have one. 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. For that matter, as a dialysis RN for several years in a busy hospital unit, I had never heard of home dialysis in any form–a truth I have noted in most of my colleagues, as well. Third, there seems to be no patient modality education done around here. 80% of the patients I approach have never heard of nocturnal dialysis.
So, I find my “training nurse” job is neither training nor nursing; it’s sales and marketing. I’ve got a big meeting coming up with upper management levels about how to kickstart this program. Any thoughts?

Thanks!

[Dori_Schatell]

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

[Beth_Witten_MSW_ACSW]

Dori mentioned how many people find Home Dialysis Central. I hope your clinic is listed in our Find a Center database linked from our home page. If not, you can add it to get a free basic listing that has your contact information and what home treatment options your clinic offers.

Some dialysis corporations are sponsors of Home Dialysis Central. They get premier listings based on the amount they donate. If your corporation is not yet a sponsor, encourage them to consider it. Askthem to choose your clinic to be one of the premier listings they tell us to add.

Clinics that are independent or corporate owned can choose to have their own premier listings that provides much more information than the basic listing. The cost for a clinic is $480/year. A premier listing tells people how to contact you by email, your medical director, how many training staff there are, what your hours of operation are. Look for “Premier Center Listing:”
http://www.homedialysis.org/v1/support/

As you see if you look at the sample, we can post a picture that you think provides the best representation of your program. As they say, a picture paints 1000 words. Speaking of words, we can also include a 300 word description that tells patients why they’d want to come to your clinic and doctors why they should refer to you. What would patients (and doctors or other healthcare providers) want to know?
– what dialysis equipment you use;
– your attitude about home dialysis;
– patient outcomes including satisfaction;
– innovations in training people with special needs like illiterate, visually or hearing impaired or working patients;
– quotes from happy and healthy patients;
– anything else that you think will market your home dialysis program. If you have PD too, you can talk about that in your description as well.

Have you thought of having a weekend meeting on NHHD in conjunction with an open house to show off your NHHD program to patients and professionals? I bet your panel of patients even though small would be your best promoters.

[system]

Unless nephs and dialysis staff tell patients the truth, that daily dialysis will make them feel better, they are more than capable of doing self-care and it will give them their lives back, most patients will stay stuck in a rut and there will be few takers for home txs. Instead of allowing patients to vegetate, nephs and staff must educate! This has been the problem all along…patients have been lied to and held back!! They are like birds in a cage who think they can not get out!!! Nephs and staff must demonstrate to every capable patient that they have what it takes to go free to that better tx. It is time to stop standing in their way.