Continuous peritoneal dialysis and the extended care facility.
The projected disproportionate increase in the number of elderly patients reaching end-stage renal disease constitutes a dramatic change in dialysis demographics. The nursing home or extended care facility (ECF) will become an increasingly important feature of care for both rehabilitation and long-term patient management. For continuous peritoneal dialysis (CPD), the ECF has been critically evaluated in only a single specialized, university-based, geriatric facility that included trained peritoneal dialysis nurses providing care. We have trained multiple ECF personnel in 10 community-based ECFs to provide all CPD-related therapy for 93 patients between November 1993 and December 1998, for a total of 289.3 patient-months. All ECFs have maintained their CPD program. Outcome measures, including hospitalization, mortality, technique failure, and peritonitis rates, show the success and feasibility of using community-based ECFs for CPD. The use of multiple ECFs for CPD appears to offer distinct advantages over solo structured ECF programs without jeopardizing outcomes. A highly structured CPD education program for ECF personnel by nephrology staff is manageable and appears critical for the success of maintaining CPD in the ECF.
Yale University and Hospital of Saint Raphael, New Haven, CT, USA. hcarey@snet.net
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Carey
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Chorney
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Pherson
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Finkelstein
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Kliger
D000368:Aged; D002423:Cause of Death; D005260:Female; D006738:Hospices; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009740:Nursing Staff / Q000193:education; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects; D010538:Peritonitis / Q000209:etiology / Q000382:microbiology; D010823:Physician Assistants; D010820:Physicians; D012866:Skilled Nursing Facilities