Action Items |
International Standards and Cooperation Action recommendations were centered around home dialysis education, training, and advocacy standardization across countries:
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1)
Development of centralized centers of excellence in home dialysis throughout both developing and developed countries,
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2)
Standardization of home dialysis education and training for clinicians and health care professionals working with nephrology and dialysis,
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3)
Alignment and regional tailoring of advocacy messages through patients and caregivers to motivate policy makers to action in favor of home dialysis strategies, and
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4)
Educational and comprehensive education programs about needs of patients and caregivers to reduce the burden of dialysis.
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Patient Empowerment and Education Action recommendations focused on supporting and amplifying existing broad-based patient education efforts and establishing new avenues for creating awareness:
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1)
Establishment of kidney disease awareness campaigns through social media and patient-centered events in collaboration with patient-led organizations;
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2)
Development and delivery of country-specific home dialysis training modules to clinicians and patients, such as the International Society for Peritoneal Dialysis and International Society for Hemodialysis’s current educational materials29;
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3)
Focus on patient stories on a local, national, and regional basis for use in advocacy, provider education and patient awareness programs;
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4)
Commitment to work together to create and promote in-person and virtual patient education programs; and
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5)
Involvement of patients in home dialysis education for patients and clinicians.
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Culture of Support for Home Dialysis Action recommendations focused on developing and sharing advocacy and educational programs for home dialysis clinicians, across global organizations:
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1)
Creation of programs across global kidney disease organizations, such as the World Kidney Disease Games, International Congress of Nephrology, International Society of Nephrology, and organizations focused on related conditions, such as diabetes, cardiovascular disease and cancer, to advocate across specialties for policy and practice changes related to home dialysis;
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2)
Development of clinician training programs for certain key procedures related to dialysis initiation (eg, the South African and Latin American peritoneal dialysis catheter implantation training programs)30, 31, 32;
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3)
Expansion of an international webinar program aimed at educating clinicians about home dialysis, including one that the International Society of Peritoneal Dialysis is currently leading29;
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4)
Creation of regional clinician mentoring programs, such as Project ECHO in the United States, and the International Society of Nephrology sister center programs33,34; and
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5)
Involvement of home dialysis patients in all these actions because their own home dialysis experience is conveyed directly to other patients, to clinicians, and to policy makers.
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Mitigation of Institutional or Governmental Roadblocks Action recommendations focused on engaging policy leaders in varied countries to close the gap between in-center and home dialysis reimbursement:
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1)
Creation of country-wide best practices on how to advocate with policymakers to ensure that vascular access, peritoneal dialysis catheter placement, and home hemodialysis training programs are prioritized;
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2)
Incentivized peritoneal dialysis catheter training programs to promote catheter placement;
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3)
Research efforts that seek to determine how payment policy affects uptake and which barriers to home dialysis are unrelated and how changes to government policy could affect home dialysis uptake levels; and
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4)
Involvement and engagement of health care leaders, such as executives of health systems, health policy experts, and health care organization leaders.
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