Table 4.
Experience of asPD across 13 European countries
| Country | Personal experience | Country experience | Who are the assistants | Funding of assisted PD |
|---|---|---|---|---|
| Austria | asPD since 2007. 45 PD; 6 on asAPD—uses own PD nurses in homes or nursing homes | asPD in two other PD centres; not available nationwide. Recently submitted project plan for widespread aPD to federal government | Family members Since 2015, nurses without nephrology experience allowed, but no funding. Assistance provided by PD nurses |
No funding for assistance |
| Denmark | Established a programme for asAPD in 1999 | asPD available in all centres, but great variability in numbers related to doctors’ preferences. Total PD penetration 20%; 11% PD patients on asAPD and 4% on asCAPD | Professional nurses or health care assistants in patients’ own homes or nursing homes staff | Fully funded by public healthcare system |
| Finland | asPD for 20 years. Currently, 2 patients, but plans to increase to 10–20 | Successful programmes in smaller hospitals and regions. More difficult to build networks in bigger cities | Family members, home care staffs and personal assistants | No funding for assistance. Patient pays separately for all visits up to €50/day |
| France | asPD always available even when training as nephrologist | Nurse-assisted PD is covered by the healthcare insurance since 1977, fully covered since 1993. Nurse-assisted PD in nursing homes covered since 2011 | Community nurses working in the private sector Family members |
Funded by the healthcare insurance. Private nurses are paid for CAPD or APD; payment is based on the number of exchanges on CAPD |
| Germany | Low awareness of asPD among health insurance companies. Sometimes very difficult individual requests, as there is no regulation for reimbursement. Permits often only after objection. High staff turnover among care providers. Staff shortages both at care providers and in dialysis teams |
Obstacles due to lack of funding in Germany asPD is not part of the standard reimbursement for care providers Complex individual requests make asPD unattractive Staff shortages at care providers lead to supply bottlenecks |
Family members Professional outpatient and inpatient care providers |
Reimbursement according to individual requests to the patient's health insurance by nursing services Different levels of reimbursement for service provision of depending on health insurance fund and region Family members do not receive benefit payments |
| Greece | No asPD as no public home-based healthcare services | None | Occasional family members. Nurses from the public sector are not allowed to visit houses | No funding for assistance |
| Ireland | Mostly family supported. Occasional use of private healthcare companies | No formal asPD programme | Family members. Occasional nursing home staff members |
No funding for assistance |
| Italy | 32% asPD; 33% non-family caregivers | Italian PD census 2019: 3466 patients, 24% asPD; 22% in 2016 | Italian PD Census 2019 for asPD: 84.1% family caregiver, 6.6% institutional care, 4.7% retirement home personnel and 4.4% caregiver paid by the family | No funding for assistance. Pilot projects are funded by regional governments (Sicily, Piedmont) reimbursing family members |
| Norway | asPD grown from a few family assisted PD to 20%–30% prevalent PD programme over last 10 years | asPD available across country, both CAPD with 3–4 visits a day and APD | Healthcare personnel (nurse or non-professional) in community or nursing homes. Sometimes family members | Fully funded by public healthcare system |
| Portugal | 20% prevalent patients on asPD. Helper always family member—not paid | No asPD programme—regional or national. An asPD taskforce was created in 2021 | Family members. Nursing homes or rehabilitation centres—depends on good will | No funding for assistance |
| Spain | 10%–15% incident patients on asPD. Started programme to keep prevalent patients on PD | Published experience of asPD is scarce. Some regional experience: Canary Islands, Basque Country, Alicante and Castilla y León | 50% assistance provided by spouses; 10% by non-health care worker. Nursing home staff trained by PD team—philanthropic as no payment | No funding for assistance. In the past, in the Canary Islands, caregivers received a fixed salary of €20 /day (€7280/year) per patient, for both CAPD and APD. Stopped 10 years ago |
| Sweden | 10% of prevalent PD patients; want to grow | asPD prevalence slowly increasing, from 11% in 2010 to about 16% of prevalent PD patients in 2020 | Community healthcare personnel, family members, nursing home staff. Varies between regions, with different access to community nurses to perform asPD | Fully funded by public healthcare system |
| UK | Started asPD with healthcare assistant in 2005; initial model was APD with one visit/day. Currently, 25% prevalence with 17asAPD and 25asCAPD Shortage of assistants mean patients have missed visits |
Widely available in England; less so in other countries. Mostly asAPD with one visit/day. CAPD available in some centres. 5%–20% PD patients on asPD depending on centre | ‘Technicians’ (no professional healthcare training) from national healthcare agency trained and funded by Baxter; employed and trained directly by some units Family support if limited to 1 visit/day for APD or CAPD (usually 2 visits/day) |
Funded by public healthcare system for 1 visit/day. Renal unit absorbs cost of second visit when used |
Abbreviations: APD, automated peritoneal dialysis; CAPD, continuous ambulatory peritoneal dialysis.