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A clinical and cost evaluation of hemodialysis in renal satellite units in England and Wales

A clinical and cost evaluation of hemodialysis in renal satellite units in England and Wales
A clinical and cost evaluation of hemodialysis in renal satellite units in England and Wales
Background: the prevalence rate of renal replacement therapy in the United Kingdom has increased significantly, particularly by long-term hemodialysis (HD) therapy in renal satellite units (RSUs). These are largely nurse-run units linked to main renal units (MRUs). We compared outcomes, processes of care, and costs in RSUs with those in MRUs.

Methods: a cross-sectional comparison was performed of HD patients from a representative sample of 12 RSUs in England and Wales and HD patients in the linked MRUs deemed suitable by the senior nurse for RSU care. Data for patient characteristics, clinical process and outcome measures, health-related quality of life (HRQoL), and patient satisfaction were collected. A partial analysis of National Health Service and social care costs was undertaken. Geographic access was assessed by road time and distance traveled to dialysis sessions.

Results: seven hundred thirty-six of 895 eligible patients (82%) participated. RSU patients were older (mean age, 63 versus 57 years), but had comorbidity similar to that of MRU patients. There were no significant differences in most processes of care or clinical outcomes; achievement of standards for adequacy of dialysis (urea reduction ratio) was significantly greater in RSU patients and hospitalization in the last year was less frequent. Patient HRQoL was similar, but patient satisfaction was greater in RSU patients. RSU patients potentially saved 19 minutes traveling for each dialysis session. Costs for routine dialysis and health/social care were similar.

Conclusion: RSUs appear to be as effective as main HD units for a wide spectrum of patients, improve geographic access, and are more acceptable to patients. There is evidence that they are as cost-effective as main units.
hemodialysis (hd), satellite units, effectiveness, costs, accessibility, acceptability
0272-6386
121-131
Roderick, Paul
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Armitage, Alison
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Nicholson, Tricia
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Mehta, Raj
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Gerard, Karen
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Mullee, Mark
fd3f91c3-5e95-4f56-8d73-260824eeb362
Drey, Nick
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Lamping, Donna
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Feest, Terry
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Greenwood, Roger
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Townsend, Joy
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Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Armitage, Alison
80239c9a-f7b2-472a-a278-b7296dd5a515
Nicholson, Tricia
557b63c5-30eb-4c42-98d3-a3d71eb11c75
Mehta, Raj
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Gerard, Karen
1aef0321-add2-425f-8cd6-48f1adeef928
Mullee, Mark
fd3f91c3-5e95-4f56-8d73-260824eeb362
Drey, Nick
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Lamping, Donna
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Feest, Terry
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Greenwood, Roger
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Townsend, Joy
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Roderick, Paul, Armitage, Alison, Nicholson, Tricia, Mehta, Raj, Gerard, Karen, Mullee, Mark, Drey, Nick, Lamping, Donna, Feest, Terry, Greenwood, Roger and Townsend, Joy (2004) A clinical and cost evaluation of hemodialysis in renal satellite units in England and Wales. American Journal of Kidney Diseases, 44 (1), 121-131. (doi:10.1053/j.ajkd.2004.03.031).

Record type: Article

Abstract

Background: the prevalence rate of renal replacement therapy in the United Kingdom has increased significantly, particularly by long-term hemodialysis (HD) therapy in renal satellite units (RSUs). These are largely nurse-run units linked to main renal units (MRUs). We compared outcomes, processes of care, and costs in RSUs with those in MRUs.

Methods: a cross-sectional comparison was performed of HD patients from a representative sample of 12 RSUs in England and Wales and HD patients in the linked MRUs deemed suitable by the senior nurse for RSU care. Data for patient characteristics, clinical process and outcome measures, health-related quality of life (HRQoL), and patient satisfaction were collected. A partial analysis of National Health Service and social care costs was undertaken. Geographic access was assessed by road time and distance traveled to dialysis sessions.

Results: seven hundred thirty-six of 895 eligible patients (82%) participated. RSU patients were older (mean age, 63 versus 57 years), but had comorbidity similar to that of MRU patients. There were no significant differences in most processes of care or clinical outcomes; achievement of standards for adequacy of dialysis (urea reduction ratio) was significantly greater in RSU patients and hospitalization in the last year was less frequent. Patient HRQoL was similar, but patient satisfaction was greater in RSU patients. RSU patients potentially saved 19 minutes traveling for each dialysis session. Costs for routine dialysis and health/social care were similar.

Conclusion: RSUs appear to be as effective as main HD units for a wide spectrum of patients, improve geographic access, and are more acceptable to patients. There is evidence that they are as cost-effective as main units.

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More information

Published date: July 2004
Keywords: hemodialysis (hd), satellite units, effectiveness, costs, accessibility, acceptability

Identifiers

Local EPrints ID: 24491
URI: http://eprints.soton.ac.uk/id/eprint/24491
ISSN: 0272-6386
PURE UUID: d14c1e57-4f29-4d15-8fff-43ff1ec612d9
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850

Catalogue record

Date deposited: 30 Mar 2006
Last modified: 09 Jan 2022 02:47

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Contributors

Author: Paul Roderick ORCID iD
Author: Alison Armitage
Author: Tricia Nicholson
Author: Raj Mehta
Author: Karen Gerard
Author: Mark Mullee
Author: Nick Drey
Author: Donna Lamping
Author: Terry Feest
Author: Roger Greenwood
Author: Joy Townsend

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