Authors (including presenting author) :
Lee SH(1), Li KYK(2), Chan WMM(2)(3), Tsang M(4), Ho LF(1), Au CP(1), Tang HL(1), Cheuk A(1), Yik WMJ(1), Chan NY(1)
Affiliation :
(1) Nephrology Unit, Department of Medicine and Geriatric, Princess Margaret Hospital
(2) Community Care, Princess Margaret Hospital
(3) Community Health Care, Kowloon West Cluster
(4) Medical Social Services Unit, Princess Margaret Hospital
Introduction :
Home-based peritoneal dialysis (PD) is an effective treatment for end-stage renal disease (ESRD). Since 1985, Hong Kong's 'PD First Policy' mandates PD as the primary treatment unless contraindicated. The aging population has increased the demand for PD care in Residential Care Homes for the Elderly (RCHEs), with 47 patients (10.4% of PMH PD patients) residing in these facilities as of 1 August 2024. However, varying and substandard PD care in RCHEs has led to complications, hospital admissions, and patient suffering. In response, a Medical-social Collaboration (MSC) pilot program was proposed in April 2024 to enhance Continuous Ambulatory Peritoneal Dialysis (CAPD) care in RCHEs.
Objectives :
1. Enhance CAPD care in RCHEs by updating staff knowledge and skills.
2. Identify RCHEs with compliant CAPD care in Kwai Tsing District.
3. Provide a list of recognized RCHEs for patient, family, and hospital reference in discharge planning.
Methodology :
In collaboration with PMH Renal Team, KWC Community Health Care, PMH Community Care Team, PMH Medical Social Services Unit, and the Renal Patient Support Group, the program commenced in September 2024 with three elements:
1. Two webinars on CAPD care for RCHE healthcare staff were conducted on 13 and 23 September 2024.
2. Joint visits to 11 RCHEs in Kwai Ching District assessed CAPD standards for 20 PMH PD patients from October 2024 to January 2025.
3. A CAPD workshop on 10 January 2025, provided specialized skill training for RCHE healthcare workers.
Result & Outcome :
A total of 105 RCHEs (99% of those in Kwai Chung and Tsuen Wan District) and 262 staff attended the CAPD talks, with over 96% positive feedback. Knowledge scores improved by 19%, from 6.4 to 7.6. During visits, a checklist assessed RCHE environments and CAPD procedures, with immediate recommendations provided. Social Welfare Department (SWD) Health Inspectors and the Community Care Team became aware of RCHE needs for CAPD patients. One RCHE with suboptimal care joined a 'Train-the-trainer' workshop on 10 January 2025, where all participants passed skill assessments. Follow-up visits will monitor ongoing performance. Among the 20 CAPD patients in the visited RCHEs, there was an increase in day ward visits for contamination management, but no admissions due to peritonitis post-program. A list of recognized RCHEs for CAPD care in Kwai Tsing District was compiled.
This pilot MSC program, supported by clinical, social, and community efforts, effectively enhances PD care for elderly renal patients in RCHEs, ensuring sustainable and cost-effective standards.
