Chronic kidney disease and support provided by home care services: a systematic review
1 School of Population and Public Health, The University of British Columbia and Provincial Health Services Authority, 700-1380 Burrard Street, Vancouver, BC V6Z 2H3, Canada
2 Faculty of Medicine, Section of Nephrology, University of Manitoba and Seven Oaks General Hospital, Room 2PD02 – 2300 McPhillips Street, Winnipeg, MB R2V 3M3, Canada
3 British Columbia Provincial Renal Agency, Providence Bldg, Room 570.4, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
4 Division of Nephrology, Providence Bldg, Room 6010A, The University of British Columbia and British Columbia Provincial Renal Agency, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
BMC Nephrology 2014, 15:118 doi:10.1186/1471-2369-15-118Published: 18 July 2014
Chronic diseases, such as chronic kidney disease (CKD), are growing in incidence and prevalence, in part due to an aging population. Support provided through home care services may be useful in attaining a more efficient and higher quality care for CKD patients.
A systematic review was performed to identify studies examining home care interventions among adult CKD patients incorporating all outcomes. Studies examining home care services as an alternative to acute, post-acute or hospice care and those for long-term maintenance in patients’ homes were included. Studies with only a home training intervention and those without an applied research component were excluded.
Seventeen studies (10 cohort, 4 non-comparative, 2 cross-sectional, 1 randomized) examined the support provided by home care services in 15,058 CKD patients. Fourteen studies included peritoneal dialysis (PD), two incorporated hemodialysis (HD) and one included both PD and HD patients in their treatment groups. Sixteen studies focused on the dialysis phase of care in their study samples and one study included information from both the dialysis and pre-dialysis phases of care. Study settings included nine single hospital/dialysis centers and three regional/metropolitan areas and five were at the national level. Studies primarily focused on nurse assisted home care patients and mostly examined PD related clinical outcomes. In PD studies with comparators, peritonitis risks and technique survival rates were similar across home care assisted patients and comparators. The risk of mortality, however, was higher for home care assisted PD patients. While most studies adjusted for age and comorbidities, information about multidimensional prognostic indices that take into account physical, psychological, cognitive, functional and social factors among CKD patients was not easily available.
Most studies focused on nurse assisted home care patients on dialysis. The majority were single site studies incorporating small patient populations. There are gaps in the literature regarding the utility of providing home care to CKD patients and the impact this has on healthcare resources.