SP749
EXPLORING THE DETERMINANTS OF THE EXPERIENCE OF CARE FOR IN-CENTER HEMODIALYSIS PATIENTS: SURVEY FROM ONE LARGE PRIVATE DIALYSIS NETWORK IN ROMANIA Free

Introduction and Aims: Improvement in outcomes for chronic diseases needs a holistic approach addressing not only the technical aspects of medical care but also the governance of care provision and the strategies for gaining adherence to the constraints of a chronic illness in a cost-effective manner. Changing the patterns of care provision towards a real patient-centeredness which involves genuine patient-caregiver partnership and patient is a challenging task. The aim of the Experience of Care working-group from IHS was to analyze the elements of care that in-center hemodialysis patients value most, in order to develop policies addressing their needs.

Methods: A cross-sectional survey was performed during July 2014 among 327 randomly selected patients out of the 1327 patients undergoing in-center hemodialysis in the 13 dialysis units of the network. The questionnaires were elaborated by the multidisciplinary group of experts (senior nephrologists, dialysis nurses, clinical psychologists, educational specialists, quality and operational managers). The internal consistency of the questionnaire was assessed using Cronbach’s alpha statistic (alpha value 0.655). Demographic data were collected for each respondent (sex, age, educational level, dialysis vintage and place of living). The subjects were invited to grade various aspects of the in-center hemodialysis care (treatment, staff, communication and relationship, infrastructure, operational issues, additional services like transportation, catering, etc.), as well as related attitudes and behaviors by the personally perceived importance. In order to better serve the exploratory scope of this survey, we performed the analysis using the Bayesian network modeling and data mining functions of the BayesiaLab Professional Edition 5.2 software.

Results: Valid questionnaires were obtained from 278 subjects, which gives an error margin of 5 at a 95% confidence level. The mean age of the respondents was 58.66±13.52 years, 50.4% F vs. 49.6% M. 56.1% came from urban areas. The mean duration of dialysis was 4.71±3.96 years.

The most striking result was the inverse correlation between the valued items: “professionalism”, “efficient treatment” on one hand and “care”, “kindness”, “warmth of the heart” on the other, suggesting a perceived dichotomy between the technical part of medical care and the more humane attributes of it, that could originate either in the culturally induced perception on the medical staff or in the lower level of health literacy that doesn’t enable the respondents to evaluate that technical part. These groups are almost identical in size (49.3% vs. 50.7%). The group of subjects favoring the humanistic component of care has a lower education level and resides more frequently in the rural area. This group values more the services from less specialized staff, is less interested in getting information about the disease and grades higher additional services like catering.

Conclusions: Moving from the authoritative model of healthcare to the collaborative one which favors proficient therapeutic relationships between the patient and the caregiver has to deal both with the paradigms of the healthcare system and with the patients’ beliefs and understanding, which are undoubtedly influenced by the level of health literacy,societal practices and culture. Unveiling and addressing the real care needs, expectations management and health education programs should be considered for attaining this goal.