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The economic considerations of patients and caregivers in choice of dialysis modality

Introduction Broader adoption of home dialysis could lead to considerable cost savings for health services. Globally, however, uptake remains low. The aim of this study was to describe patient and caregiver perspectives of the economic considerations that influence dialysis modality choice, and elic...

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Autores principales: Walker, Rachael C., Howard, Kirsten, Tong, Allison, Palmer, Suetonia C., Marshall, Mark R., Morton, Rachael L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324572/
https://www.ncbi.nlm.nih.gov/pubmed/27196634
http://dx.doi.org/10.1111/hdi.12424
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author Walker, Rachael C.
Howard, Kirsten
Tong, Allison
Palmer, Suetonia C.
Marshall, Mark R.
Morton, Rachael L.
author_facet Walker, Rachael C.
Howard, Kirsten
Tong, Allison
Palmer, Suetonia C.
Marshall, Mark R.
Morton, Rachael L.
author_sort Walker, Rachael C.
collection PubMed
description Introduction Broader adoption of home dialysis could lead to considerable cost savings for health services. Globally, however, uptake remains low. The aim of this study was to describe patient and caregiver perspectives of the economic considerations that influence dialysis modality choice, and elicit policy‐relevant recommendations. Methods Semistructured interviews with predialysis or dialysis patients and their caregivers, at three hospitals in New Zealand. Interview transcripts were analyzed thematically. Findings 43 patients and 9 caregivers (total n = 52) participated. The three themes related to economic considerations were: (i) productivity losses associated with changes in employment; (ii) the need for personal subsidization of home dialysis expenses; and (iii) the role of socio‐economic disadvantage as a barrier to home dialysis. Patients weighed the flexibility of home dialysis which allowed them to remain employed, against time required for training and out‐of‐pocket costs. Patients saw the lack of reimbursement of home dialysis costs as unjust and suggested that reimbursement would incentivize home dialysis uptake. Social disadvantage was a barrier to home dialysis as patients’ housing was often unsuitable; they could not afford the additional treatment costs. Home hemodialysis was considered to have the highest out‐of‐pocket costs and was sometimes avoided for this reason. Discussion Our data suggests that economic considerations underpin the choices patients make about dialysis treatments, however these are rarely reported. To promote home dialysis, strategies to improve employment retention and housing, and to minimize out‐of‐pocket costs, need to be addressed directly by healthcare providers and payers.
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spelling pubmed-53245722017-03-08 The economic considerations of patients and caregivers in choice of dialysis modality Walker, Rachael C. Howard, Kirsten Tong, Allison Palmer, Suetonia C. Marshall, Mark R. Morton, Rachael L. Hemodial Int Quality of Life, Outcomes Introduction Broader adoption of home dialysis could lead to considerable cost savings for health services. Globally, however, uptake remains low. The aim of this study was to describe patient and caregiver perspectives of the economic considerations that influence dialysis modality choice, and elicit policy‐relevant recommendations. Methods Semistructured interviews with predialysis or dialysis patients and their caregivers, at three hospitals in New Zealand. Interview transcripts were analyzed thematically. Findings 43 patients and 9 caregivers (total n = 52) participated. The three themes related to economic considerations were: (i) productivity losses associated with changes in employment; (ii) the need for personal subsidization of home dialysis expenses; and (iii) the role of socio‐economic disadvantage as a barrier to home dialysis. Patients weighed the flexibility of home dialysis which allowed them to remain employed, against time required for training and out‐of‐pocket costs. Patients saw the lack of reimbursement of home dialysis costs as unjust and suggested that reimbursement would incentivize home dialysis uptake. Social disadvantage was a barrier to home dialysis as patients’ housing was often unsuitable; they could not afford the additional treatment costs. Home hemodialysis was considered to have the highest out‐of‐pocket costs and was sometimes avoided for this reason. Discussion Our data suggests that economic considerations underpin the choices patients make about dialysis treatments, however these are rarely reported. To promote home dialysis, strategies to improve employment retention and housing, and to minimize out‐of‐pocket costs, need to be addressed directly by healthcare providers and payers. John Wiley and Sons Inc. 2016-05-15 2016-10 /pmc/articles/PMC5324572/ /pubmed/27196634 http://dx.doi.org/10.1111/hdi.12424 Text en © 2016 The Authors. Hemodialysis International published by Wiley Periodicals, Inc. on behalf of International Society for Hemodialysis. This is an open access article under the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Quality of Life, Outcomes
Walker, Rachael C.
Howard, Kirsten
Tong, Allison
Palmer, Suetonia C.
Marshall, Mark R.
Morton, Rachael L.
The economic considerations of patients and caregivers in choice of dialysis modality
title The economic considerations of patients and caregivers in choice of dialysis modality
title_full The economic considerations of patients and caregivers in choice of dialysis modality
title_fullStr The economic considerations of patients and caregivers in choice of dialysis modality
title_full_unstemmed The economic considerations of patients and caregivers in choice of dialysis modality
title_short The economic considerations of patients and caregivers in choice of dialysis modality
title_sort economic considerations of patients and caregivers in choice of dialysis modality
topic Quality of Life, Outcomes
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324572/
https://www.ncbi.nlm.nih.gov/pubmed/27196634
http://dx.doi.org/10.1111/hdi.12424
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