onward a day-to-day basis, peritone...

onward a day-to-day basis, peritoneal dialysis is as effective as hemodialysis, and studies have set up either no differences in mortality between the sum of two units modalities or better survival rates with peritoneal dialysis. Hemodialysis requires traveling to a facility three times a week; peritoneal dialysis can be performed daily at to one's home either manually or using an automated theory Rubin and colleagues sought to determine patient elections by comparing evaluations of patients receiving different images of dialysis treatment.

The Choices for Healthy results in Caring for End-Stage Renal Disease (CHOICE) research prospectively enrolled patients at 81 dialysis center who had initiated outpatient dialysis within the previous three month Measures included a validated, chart-based comorbidity and severity-of-illness measure, health status measures, and self-administered questionnaires to assess patient evaluations and satisfaction with care.

There were 336 eligible hemodialysis respondent and 185 peritoneal dialysis respondent The best-rated unadjusted items were similar in the sum of two units groups: caring and concern of cherishs caring and concern of dialysis center staff, answer to pain, and availability in push The two groups also agreed in succession four of the five worst-rated items: coordination among nephrologists and other doctors, for what cause often the nephrologist sees the patient, the amount of fluid remov during dialysis, and the accuracy of information received from nephrologists.

Peritoneal dialysis patients also rated the ease of reaching the nephrologist among the worst-rated items, and the hemodialysis patients included the amount of information given to help them select hemodialysis or peritoneal dialysis. Patients undergoing peritoneal dialysis rated their care abundant higher than hemodialysis patients rated their care, with 85 percent of the former clump rating overall care as thoroughly good compared with 56 percent of hemodialysis patients. The greatest differences were build in the items "information given to help pick out modality" and "amount of dialysis information from staff." After adjustment, peritoneal dialysis patients gave higher ratings to all 23 inspect items. This difference held in sensitivity and subgroup analyses.

Peritoneal dialysis patients were 15 times more likely to rate their dialysis care as worthy overall than were hemodialysis patients, regardless of demographic and health status characteristics. In particular, peritoneal dialysis patients rated the information allowing them to single out between modalities much higher than hemodialysis patients did.

Peritoneal dialysis may be les splendid than hemodialysis, but physicians may pick hemodialysis because of reimbursement inclinations Planned payment policies would have to adapt to allow the costliness savings that could be realized if more patients were to make choice of peritoneal dialysis. This study indicates that peritoneal dialysis is associated with greater patient satisfaction.

CAROLINE WELLBERY, MD Rubin HR et al. Patient ratings of dialysis care with peritoneal dialysis v hemodialysis. JAMA February 11 2004;291:697-703

COPYRIGHT 2004 American Academy of Family Physicians

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