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.
Carey
H B
HB
Yale University and Hospital of Saint Raphael, New Haven, CT, USA. hcarey@snet.net
Chorney
W
W
Pherson
K
K
Finkelstein
F O
FO
Kliger
A S
AS
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