FP660A EUROPEAN MULTICENTER ANALYSIS OF HAEMODIALYSIS PATIENT EXPERIENCES AND SATISFACTION - RELATION TO PRACTICES AND GUIDELINES

Abstract

Introduction and Aims: Understanding patient values and exploring their preferences are critical to caring for the dialysis population. Patient-centered outcomes such as engagement, symptoms and satisfaction may not necessarily align with the physician-centered priorities, achieving clinical targets and reducing morbidity and mortality. Little is known about the factors that influence patients' experiences and satisfaction and how to improve patients' perception of care as compared with other routinely measured clinical indices of care (anaemia, CKD-MBD etc.). In addition, uncertainty about factors influencing patient values is further amplified by differences in attitudes, expectations and normative practices. These issues were investigated in this large international European multicentre descriptive analysis. Methods:We enrolled 845 haemodialysispatients from 13DaVita centres in Poland (8 centres, n=453) and Portugal (5 centres, n=392) in this study. An anonymous patient survey (14 questions, 5 graded scale, "agree completely to disagree") focusing on patient experiences and satisfaction with their care at the local facility was con-ducted. Furthermore, practices, demographic and routine laboratory data were analysed the same month as the survey was performed and correlated to the anonymous survey results at the facility level. Results: The survey response rate was 81% (range 72-100%). Demographic and laboratory data at the facility level were: mean age 68 (14 SD), 53% males, Charlson comorbidity index 7.1 (3.0),HD 50.3%, HDF 49.7%, AVF 76.3%, CVC 16.5%, KT/V 1.8 (0.4), albumin 39.5 (4.3) g/L, P 4.7 (1.3) mg/dL and PTH 512 (481) pg/mL. The patient satisfaction score (0-10) was high 9.1 (1.6) and the net promoter score (NPS) 71. High scores (>90% "agree") were observed for 13 of 14 questions (I'm treated with respect., I'm involved., The staff spend enough time., I feel safe., The clinic is clean.etc), except for "I'm happy with my transportation provider" (85% "agree"). There were significant differences in patient satisfaction between dialysis facilities in both countries. Spearman correlation analyses at the facility level (n=13) showed that patients "involved in decision making" had significantly higher KT/V (p=0.02). Furthermore, patients who "agreed" to that their "chairs and linen were comfortable" had significantly lower P (p=0.02) and higher KT/V (p<0.001). Patients "happy with their transportation provider" had higher KT/V (p=0.002) and lower P (p<0.05) and patients who agreed that their "treatment started on time" had higher KT/V (p=0.05). However, the overall satisfaction score was higher with low KT/V (p=0.004) and high P (p<0.05). Conclusions: Patient experience and satisfaction surveys provide a critical and unique perspective on the quality of patient-centred healthcare delivery. Information derived from direct evaluation of patient experience of care and patient satisfaction can be used to identify areas for improvement and support changes in care provision with the aim of improving the overall quality of care for patients.