Implementation ‘Nierteam aan Huis’:

Kidney transplantation with a kidney from a living donor is the optimal treatment for most patients with end-stage renal failure. However, there is a significant number of patients who can not find a living kidney donor. Research shows that both knowledge of different renal replacement therapies and discussing this knowledge with family and friends, play an important role. The ‘NierTeam aan Huis’ of the Erasmus MC has investigated the effectiveness of home education in patients without a living donor. Patients and their family/friends received two home visits in addition to the regular hospital information. The first visit took only place with the patient and partner and was intended to map the family and household culture. The patient could then invite family and friends for the second home visit. The aim of this second visit was to provide information on kidney disease, dialysis, kidney transplantation and living kidney donation with highlighting the psychosocial aspects. Central to his was promoting communication between the patient and his/her social network about the different forms of treatment. For this the communication model and skills as elaborated in the ‘multi-system therapy’ (MST) were used. This therapy systematically takes into account the stability of relations and ensures that the conversation takes place with respect for individual feelings and autonomy. For this the quality system of ‘multi-systemic therapy’ was applied which involves supervision and a telephone, anonymous quality check afterwards by the patient and family members. Analyzes of the NierTeam aan Huis research show that home education has a benificial effect. The patient and family/friends who were present at the education show a significant improvement in their knowledge, a decrease in their concerns and fears related to living donation and an improvement in the mutual communication about the various treatment options. Further, preliminary analysis shows that after the home education there has been a substantial increase in the number of living kidney donations.

The activities of the NierTeam aan Huis Rotterdam have been discontinued after the planned inflow of the randomized study subsidized by the Nierstichting and the results are currently being published in international scientific presentations and publications. Given the positive results, the current project proposol describes an implementation of the ‘NierTeam aan Huis’ approach at four Dutch Academic Centres: Groningen, Amsterdam (AMC), Nijmegen and Rotterdam. The first objective of the implementation project is to map the generalizability while maintaining quality, by creating a secure framework and quality checks. The second objective is to evaluate the cost effectiveness of the education.

The implementation of group education in kidney patients' home is cost-effective

After two years.

Home-based Educational intervention in the home of kidney patients