Facilities may be the traditional setting for dialysis, but emerging home-based treatments present an opportunity to rethink kidney care. At home, patients and providers alike can enjoy benefits that dialysis clinics are unable to provide, according to Michael Aragon, MD, a nephrologist and chief medical officer at dialysis solutions firm Outset Medical.
“A patient dialyzing at home has more privacy of their own health care, more flexibility and control, (greater) patient activation — being involved in the management of their own disease,” Aragon said Tuesday in an interview with McKnight’s Home Care Daily Pulse. “And we’ve seen consistently, regardless of which patient-reported outcome measure [is used], they tend to show a higher quality of life.”
One of the most important benefits of home-based dialysis is the opportunity for clinicians to better tailor care to meet patients’ goals, Aragon noted. Clinic-based models offer patients little choice in how, where, and when they receive treatment. But at home, they enjoy much more freedom in how they get their care.
“Dialysis across the globe is single-dose therapy, three-and-a-half to four hours per treatment, three days a week,” he explained. “The entire world is essentially doing the same dialysis. Once you go home, now we can go daily if that’s what the patient needs. We can go every other day, we can go three days per week. Now the physician and the patient can align on clinical goals and patient goals, and decide [on] a therapy that meets each one of them. So the home provides physicians the flexibility to actually individualize care, which is something we don’t have in the center.”
Despite these advantages, uptake of home-based dialysis remains relatively low. Fewer than half of the dialysis centers in the US offer home options, and less than 15% of patients on dialysis are treated at home, according to Aragon.
Access barriers, a lack of education surrounding home-centered modalities and inadequate reimbursement are all partly to blame, he said. And while the Centers for Medicare & Medicaid Services has tried to encourage greater use of home-based dialysis options — notably through the End-Stage Renal Disease Treatment Choices (ETC) model — early results of the program suggest only modest gains in home dialysis training and utilization.
Still, Aragon said he believes kidney care is moving into the home. Not not only do patients want to receive care at home, but they also experience better health outcomes when they do, he noted.
“I think it’s moving home,” he said. “We kind of want to push the pace safely and with the right steps, but I think it’s going to take bringing new players in and probably some adjustment to our models.”
The McKnight’s Tech Daily is an e-newsletter for the audiences of McKnight’s Long-Term Care News, McKnight’s Senior Living and McKnight’s Home Care.
