The Implementation of a Virtual Home Dialysis Mentoring Program for Nephrologists

Results

In total, 369 physicians were invited to participate in the program. We assessed baseline demographics, attitudes, and perceptions about home therapies at the time of enrollment. Overall, 40 nephrologists participated in the preprogram survey. Exit evaluations were provided by 17 nephrologists. Most of our participants were >40 years old, male, and had practiced nephrology for between 5 and 19 years. All participants indicated they would personally opt for some form of home dialysis if they were faced with ESKD and did not have access to a living kidney transplant donor (60% continuous cycler PD, 20% short daily HHD, 12% nocturnal HHD, 8% continuous ambulatory PD). In total, 95% of our participants considered themselves as home dialysis advocates, and 68% indicated their personal approach to home modality counseling as “home first with in-center for those with barriers.” However, only 45% felt the culture of their nephrology practice could be considered as “home first.” The optimal distribution of patients on home dialysis was perceived to be “≥50%” by 40% of participants, but 87% stated the Advancing American Kidney Health Initiative goal of having 80% of patients begin RRT with home dialysis or a kidney transplant was “desirable but not a realistic goal.”

The average number of participants per session was 14 (range 4–24), excluding 2–3 moderators and the speaker. A total of 41% of postsurvey respondents attended ≥6 of the 12 sessions, whereas 59% attended 1–5 sessions. Participants’ ratings of their comfort level with PD topics pre- and post- program are shown in Figure 1A. Similarly, participants’ ratings of their comfort level with HHD topics before and after our education program are shown in Figure 1B. The net promoter score, a commonly used market research measure of the likelihood of customers to recommend a product or service to friends or colleagues, was 59. Scores >50 are generally considered as excellent. Of participants, 53% gave a score of nine or ten for how likely they perceived the program would change the perspective of participants on prescribing home dialysis (1=highly unlikely, 10=highly likely). Interestingly, 88% indicated they preferred the virtual format of the program over live, in-person.

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Figure 1.

Participant ratings. (A) Participant comfort with managing peritoneal dialysis issues. Participant comfort on baseline survey and on exit survey after completion of the virtual mentoring program. PD, peritoneal dialysis; SC, subcutaneous. (B) Participant comfort with managing HHD issues. Participant comfort on baseline survey and on exit survey after completion of the virtual mentoring program. HHD, home hemodialysis.

Qualitatively, respondents enjoyed the convenient interactive format and collegial dialogue addressing practical common home dialysis issues. Participants recommended broadening the invited audience and using additional tools within the online platform to increase engagement. In particular, respondents recommended sessions should include training nephrologists, with a focus on home dialysis–related research.