DialysisDialysisby by

Bruce Martin, MSWBruce Martin, MSWWhere do we go from here?Where do we go from here?

Obstacles Faced by The ResearchObstacles Faced by The Research

• Vastness of the disease itself

• Lack of cohesion between dialysis providers

• The relation of social work intervention and patient outcomes.

• Better understanding necessary by staff members related to patients needs.

• Larger Sample Sizes for Generalizability.

Vastness of the DiseaseVastness of the Disease

• End Stage renal Disease is not bound by geography or national borders.

• End Stage Renal Disease does not see “class” differentiation (in the general sense).

• In 2005 dialysis encompassed 6.4% of the annual Medicare budget ($21 billion) (U.S. Renal Data System 2007), this number is expected rise.

• In 2005 there where 106,000 new dialysis patients (U.S. Renal Data System 2007)

• BY 2010 the dialysis population is estimated to be at 680,938 according to U.S.R.D.S. (in 1977 there where only 40,000 patients (Malone et al 2007).

Lack of CohesionLack of Cohesion

• From the main dialysis providers Fresenius, DaVita, DCI, DSI, RAI, and many other providers of dialysis in the United States and world wide this is a business. All compete for a share of the dialysis dollar (which is ever shrinking with budget cuts).

• Because of this, there is no “real” inter-communication between providers. Each has their own task force, each has their own plan for how to tackle the ever growing dialysis population.

Social Work Intervention and Patient OutcomesSocial Work Intervention and Patient Outcomes

• Cultural implication where brought up by Tijerina (2006) related to how ones culture impacts interventions and what role that will play in outcomes.

• The significant psycho-social risk factors in dialysis patients was another implication listed by Frank et al. (2003). The patients ability to cope effectively transcends the ESRD portion of their lives into every aspect of their life.

• Another implication proposed by Raiz et al. (2007) was the importance of employment post kidney transplant. I would take this one step further and say all dialysis patients. Social Security is not a program that can be counted on to financially support the patient and family. Outcomes for post-transplant show better outcomes for those who are employed after receiving a kidney. I would propose that this would also be the case for those on dialysis.

• We know that through interventions Social Workers have a positive impact on positive outcomes on patients. Unfortunately their case loads are such that this “extra” can not be provided either at all or consistently to incur any long term affect.

Better Understanding by StaffBetter Understanding by Staff

• In Nichols et al. (1984) patients where noted to react to how they perceived staff and their fear of retribution and abandonment. This would be a good research project to determine what factor the dynamics in patient/provider play when it comes to outcomes.

• Some staff in my own experience have been known to minimize the impact the disease process has on the patient and “expect” more appropriate coping strategies by the patient.

Larger Sample SizesLarger Sample Sizes

• All studies noted the lack of statistical power related to the sample sizes they where using. The largest was 290 patients (Dobroff et al. 2001), the smallest was 34 (Nichols et al. 1984). When you compare these numbers to the total dialysis population you are left with the ability to only generalize the findings to that particular clinic or area.

• Future research (with available funding and cooperation) should attempt a larger study in order to gain statistical power.

• Reproducing studies from other locations will add to the validity and reliability of the results.