Home dialysis and home assistance: from institutional aids to a sustainable model

Abstract

Home dialysis, and mainly peritoneal dialysis, is indicated as the optimal choice as far as the comfort and lifestyle of uremic patients is concerned. Despite this, home treatments show a lack of growth. The reasons are mainly linked to the patients’ cognitive, psychosocial, familiar and physical barriers due to aging and morbidity. To overcome these barriers, we analyzed all the available institutional aids: civil disability, not-self-sufficiency funds, home, social and nursing assistance, expenses refunds. 

The assessment of the patients’ needs is performed through validated instruments such as multidimensional evaluation (VMD) and equivalent economic index (ISEE). Overall, economic relief is limited to low income patients, and those in serious distress. Some Italian regions have issued specific measures dedicated to home dialysis. Our review shows a great heterogeneity of measures, centered in some cases on economic aids and on home assistance in others. Moreover, some Italian dialysis centers directly provide caregivers for home dialysis. 

The international literature describes many experiences relating to home dialysis assistance. Their common message is that, in developed countries, economic help is generally sustainable despite the heterogeneity of health care systems. Home support and economic aids for dialysis, in fact, are made possible by the overall savings enabled by home treatments and by the careful redistributions of the funds.

Keywords: home dialysis, peritoneal dialysis, economic aids, assisted peritoneal dialysis sustainable assistance models

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Premessa

Il Piano Nazionale per la Cronicità prevede per i pazienti che necessitano di dialisi la personalizzazione delle terapie sostitutive e la domiciliarità, per il mantenimento di un buono stato funzionale e di autonomia [1]. A questo scopo è anche indicata la sperimentazione di modelli di dialisi domiciliare (sia peritoneale che emodialisi) utilizzando strumenti di teledialisi. Allo stato attuale, la dialisi peritoneale (DP) è il tipo di dialisi domiciliare più utilizzato in Italia e nel mondo [2, 3]. Alcune esperienze di emodialisi domiciliare si stanno sviluppando e costituiscono un’ulteriore area di crescita della domiciliarità [4, 5].
 

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