Innovations in renal care
Chronic kidney disease is a growing problem, particularly in developed countries. The increase in its prevalence is linked to a rise in other chronic illnesses such as obesity, diabetes or hypertension.
Frequent dialysis can mimic the normal functioning of the kidney much better than dialysis three times a week. Nocturnal home dialysis has significantly better outcomes than a haemodialysis treatment given only a few times a week at a centre or at home. In addition to better medical outcomes – which are also reflected in lower rates of hospitalisation and drug costs – nocturnal home haemodialysis has also the advantages, shared with other home-based treatments, because of the freedom and flexibility it gives to the patient. But the uptake of home-based treatments in general and especially nocturnal home haemodialysis is low. Important factors influencing the adoption of innovations renal care include guidelines and the NHS payment model changing to ‘payment by results’. Steffen Bayer, Inger Abma and I are therefore investigating how regulation, reimbursement rules and health policy impacts the provision of care for patients with chronic kidney disease.
The study is being carried out in conjunction with Manchester Royal infirmary’s BASIC-HHD project (BArriers to Successful Implementation of Care in Home HaemoDialysis), with Sandip Mitra, Paul Brencheley and Anuradha Jayanti.