Patient assessment of quality of care in a chronic peritoneal dialysis facility

The percentage of patients with end-stage renal disease (ESRD) maintained o n chronic peritoneal dialysis (CPD) in the United States remains well less than the percentage in several other countries. Furthermore, there has rece ntly been a decline in the percentage of patients with ESRD in the United S tates undergoing CPD. The reasons for this decline are uncertain, and inves tigators have implicated problems with the kinetics of peritoneal dialysis, peritonitis and exit-site infections, and psychosocial stresses imposed by the therapy. Few studies, however, have considered the role of the dialysi s facility Itself and patient perceptions of the facility as contributing t o problems with the long-term acceptance of CPD. This study Is designed to examine patients' perceptions of the organization and structure of the peri toneal dialysis facility and their interactions with the facility focusing attention on areas of patient satisfaction and dissatisfaction with the fac ility The study was conducted in a large, freestanding peritoneal dialysis program in an urban area that currently treats 140 patients undergoing CPD. Thirty patients were randomly selected to participate in the present study . A structured interview that Included open ended questions was administere d and tape-recorded by a trained interviewer not affiliated with the dialys is unit. Patient responses were then reviewed by two investigators, and a t axonomy of patient satisfaction and dissatisfaction was developed, using a modification of the classification proposed by Concato and Feinstein. Patie nt responses were then categorized according to the taxonomy. The most freq uently cited areas of patient satisfaction Included the amount of informati on and instruction provided by the staff (n = 30), personal atmosphere of t he facility (n = 30), efficiency of delivery of the dialysis supplies (n = 23), and availability of the primary nurse (n = 18). The importance of the nurse-patient interaction was emphasized by all 30 patients, whereas the ph ysician-patient interaction was cited by only 14 patients. The most frequen tly cited area of dissatisfaction noted by ail 30 patients concerned the di alysis regimen itself. The present study focuses attention on patient perce ptions of their CPD facility, Identifying areas of satisfaction and dissati sfaction. The analysis is important not only in providing a framework for C PD facilities with which to review their own interactions with CPD patients , but also for identifying those areas that require attention to maintain t he long-term viability of CPD therapy. (C) 2000 by the National Kidney Foun dation, Inc.