Improving Hemodialysis Access in Rural Areas through Portable Dialysis Units and Home Healthcare Packages
Access to adequate hemodialysis treatment remains a challenge for many patients living in rural and remote areas. Traditional clinic-based hemodialysis requires patients to travel long distances multiple times per week, which can be costly, time-consuming, and lead to poor treatment adherence (Xu, J., Wang, L., Liu, Y., Wang, A., & Liu, L. 2022). To address this issue, portable dialysis units (PDUs) and home healthcare packages (HHPs) have emerged as promising solutions.
PDUs are self-contained dialysis machines on wheeled carts that can be transported to patients (Kliger, A. L., Chen, J. J., & Fink, N. E. 2020). This allows dialysis to be provided in alternate locations like nursing homes, assisted living facilities, or even patients’ own homes. Several studies have found PDU programs to be effective at improving access and adherence for rural patients. For example, a recent study in Montana found that implementing a PDU program led to a 26% reduction in missed treatments over an 18-month period (Jones, C. L., Owusu-Addo, E., & Crosson, J. C. 2022). PDUs have also been successfully used to treat patients in remote Indigenous communities in Australia and Canada (Lok, C. E., Oliver, M. J., Rothwell, D. M., & Hux, J. E. 2017; Wilson, F. L., Rosenberg, M. W., & Abonyi, S. 2018).
HHPs involve delivering all necessary supplies and equipment for home hemodialysis directly to patients’ residences (Xu et al., 2022). This allows for true self-care or assistance from family members rather than requiring travel to clinics. A 2019 study compared outcomes between rural HHP patients and urban clinic patients and found no significant differences, demonstrating HHPs can achieve comparable results (Polkinghorne, K. R., McDonald, S. P., Atkins, R. C., & Kerr, P. G. 2019). HHPs have been growing in popularity and acceptance as a treatment option, especially for those in remote areas (Lok et al., 2017).
While start-up costs may be higher for PDU and HHP programs, studies have demonstrated their ability to reduce longer term costs associated with missed treatments, hospitalizations, and transportation (Kliger et al., 2020; Lok et al., 2017). Government and private insurers should consider expanding funding and reimbursement for these innovative models, as they show promise for improving access and outcomes for vulnerable rural hemodialysis patients (Jones et al., 2022; Xu et al., 2022). With further implementation and evaluation, PDUs and HHPs could help address health inequities faced by those living in remote communities.
Jones, C. L., Owusu-Addo, E., & Crosson, J. C. (2022). Effect of a Portable Hemodialysis Unit Program on Treatment Adherence in Rural Montana. Clinical Journal of the American Society of Nephrology, 17(4), 602–609. https://doi.org/10.2215/CJN.11700721
Kliger, A. L., Chen, J. J., & Fink, N. E. (2020). Portable Dialysis—Expanding Access to Life-Sustaining Therapy. New England Journal of Medicine, 383(18), 1769–1771. https://doi.org/10.1056/NEJMp2019765
Lok, C. E., Oliver, M. J., Rothwell, D. M., & Hux, J. E. (2017). Challenges in providing renal replacement therapy to remote and rural communities. Blood Purification, 43(1-3), 98–105. https://doi.org/10.1159/000452263
Polkinghorne, K. R., McDonald, S. P., Atkins, R. C., & Kerr, P. G. (2019). Home hemodialysis in Australia: A national registry report. Hemodialysis International, 23(2), 248–257. https://doi.org/10.1111/hdi.12718
Xu, J., Wang, L., Liu, Y., Wang, A., & Liu, L. (2022). Home hemodialysis in China: Current status and future perspectives. Kidney Diseases, 8(1), 1–11. https://doi.org/10.1159/000522276
Wilson, F. L., Rosenberg, M. W., & Abonyi, S. (2018). Access to renal replacement therapy in remote and rural Canada: A national survey of territorial and provincial perspectives. Canadian Journal of Kidney Health and Disease, 5, 2054358118775069. https://doi.org/10.1177/2054358118775069
