#3003 Increased focus on peritoneal dialysis gives patients improved quality of life and saves millions for the region
Authors: Östersund Pd Mottagningen 
Published: May 2024

Abstract

Background and Aims
Is it possible to improve PD patients' quality of life and everyday life in combination with the challenge of mastering large geographical distances and at the same time a desire to make healthcare more patient safe and enable patients to be co-creators in their dialysis care?
With an area of 48,935 km2, which corresponds to 12% of Sweden's area and larger than the whole of Denmark, Östersund Hospital is the only hospital in a region that takes care of 132,670 inhabitants.
In 2018, 85% of patients were dialyzed with hemodialysis at Östersund Hospital. Several of the patients had to travel 200-300 km one way, three to four times a week to receive their dialysis treatment. In addition to high medical travel costs for the region, this also contributed to a low quality of life for the patients. Patients of working age found it difficult to maintain their jobs due to long journeys to the hospital.
In a study by (Van Bulck et al, 2018), he shows that patients on dialysis have low participation in their care compared to other patient groups.

Method
A first step towards a change to provide an increased quality of life for the patients was to invest in self-care with peritoneal dialysis. Several studies describe peritoneal dialysis as a treatment with increased freedom that offers the patient independence with the opportunity to continue working if they are of working age (IIkka et al, AJKD 2012). In addition, several studies show several medical benefits, such as preserving the patient's residual function, which indirectly associates with better patient survival (Van de Luijtgaarden et al, NDT 2011).
To continue its work, the dialysis clinic needed approval from the region to start using a night machine connected to a cloud service. After a long wait, the dialysis clinic received approval to use the new technology.

Results
Since the digital platform was introduced, remote dialysis treatment has increased in the Jämtland Härjedalen region. Digitalization gives healthcare professionals the opportunity to follow the patient's treatment results daily and optimize dialysis treatments without the patient needing to visit the hospital. Today, work is more proactive and provides the conditions to prevent problems before they arise.
Five years ago, 85% of dialysis treatments were performed at the hospital. Today, as many as 60% of dialysis treatments with peritoneal dialysis take place in the patient's home. Already in the first year of increased self-care, the region saved SEK 6 million on reduced patient travel.
Success factors for a successful result and our way of working today:

Conclusion
With a patient centric approach, a clear goal focuses and collaboration between several different professional categories. Östersund Hospital has managed to increase the proportion of patients with home treatment from 15% to 60%.
Through the implementation of new technology in the form of a digital platform tied to a dialysis machine, the patient's treatment can be evaluated and adjusted remotely. From previously working reactively and solving problems when they arise, now working proactively and planning care for the patient. Emergency hospitalizations can be avoided. In addition to reducing the patient's suffering and providing a better quality of life with fewer hospital visits, it also promotes the hospital's finances.
By having the courage to dare to try when others say impossible, learn from their mistakes instead of seeing it as a failure, the clinic's work has improved self-care and participation for this patient group.