Making house calls increases living donor inquiries and evaluations for blacks on the kidney transplant waiting list.
BACKGROUND
Blacks receive live donor kidney transplant (LDKT) less often than patients of all other races. We evaluated the effectiveness of educational interventions in removing barriers to LDKT for blacks.


METHODS
Patients were randomized to three interventions in which health educator(s) delivered an intervention to (a) the patient and his/her guests in the patient's home (house calls [HC], n=54), (b) clusters of patients and their guests in the transplant center (group based [GB], n=49), and (c) the individual patient alone in the transplant center (individual counseling [IC], n=49).


RESULTS
At the 2-year endpoint, 15% (n=8), 8% (n=4), and 6% (n=3) of HC, GB, and IC patients, respectively, received LDKT (P=0.30). Patients in the HC group were more likely than patients in the GB and IC groups to have at least one donor inquiry (82% vs. 61% vs. 47%, P=0.001) and evaluation (65% vs. 39% vs. 27%, P<0.001). Patients in the HC group also were more likely to have higher knowledge, fewer concerns, and higher willingness to talk to others about donation 6 weeks after intervention.


CONCLUSIONS
These findings underscore the importance of including the patient's social network in LDKT education and the potential of the HC intervention to reduce racial disparity in LDKT rates.
1 Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center and the Harvard Medical School, Boston, MA. 2 Amgen, Inc., Thousand Oaks, CA. 3 Department of Medicine, University of California at Los Angeles, Los Angeles, CA. 4 Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH. 5 Address correspondence to: James R. Rodrigue, Ph.D., The Transplant Institute, Beth Israel Deaconess Medical Center, 110 Francis St., 7th Floor, Boston, MA 02215.
James R
JR
Rodrigue
Matthew J
MJ
Paek
Ogo
O
Egbuna
Amy D
AD
Waterman
Jesse D
JD
Schold
Martha
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Pavlakis
Didier A
DA
Mandelbrot
D000328:Adult; D001741:Black or African American; D000465:Algorithms; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006792:House Calls; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000601:surgery; D016030:Kidney Transplantation / Q000523:psychology*; D019520:Living Donors / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D016012:Poisson Distribution; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome; D014850:Waiting Lists