Improving the uptake of home-based dialysis therapies in Australia

21 Nov 2019

We caught up with 2012 Churchill Fellow Josephine Chow to find out about her Fellowship investigation into improving the uptake of home-based dialysis therapies and the impact her research has had in Australia.

(Above) Josephine Chow receiving her award as the winner of the National Lead Clinician Group Awards by the former Minister for Health on policy implementation related to home-based dialysis.


What made you apply for a Churchill Fellowship?

In my work, I noticed that the uptake of home-based dialysis therapies in Australia had declined despite of all the published evidence about how good it is. I wanted to increase my own personal success and capacity to implement positive change for the community regarding kidney disease. I believed that becoming a Churchill Fellow wiould enable me to access knowledge and networks to support my vision of increasing the uptake of home-based dialysis in Australia.


What was the aim of your Churchill Fellowship investigation and why is it important in the Australian context?
 

The aim of my Fellowship was to learn about the strategies used from colleagues around the world to overcome the poor perception and low uptake of home-based dialysis therapies in order to improve the uptake in Australia. Accessing this knowledge would enable the local dialysis programs to move towards more cost efficient models of dialysis that would help improve the experience of the patients and ease pressure and costs on the health system. 


What were/was the most interesting/exciting/insightful thing/s discovered on your Churchill Fellowship?

I learnt so much from colleagues overseas, in particular, being able to see their actions in practice. It was great to see the development and implementation of the identified strategies in patient centred models as well as, dedicated leadership, stakeholder engagement, succession planning, shared responsibility and accountability and how these strategies improve the experience of the patient on home-based dialysis by giving them the confidence, knowledge and skills to be actively engage in their own care. One of the major take home messages was to ensure we start at the workforce level by recruiting staff who have passion in home-based dialysis. I witnessed a simple weekly multidisciplinary rounding meeting with the senior medical clinician to support the research development team which demonstrated their commitment to teaching and training. Since coming back from my Fellowship I have initiated this style of huddle meeting in my work, bringing together relevant stakeholders from within my workplace and national and international professional groups which has resulted in a few significant successes, including grant funding, research and innovation throughput.

(Above) Josephine Chow showing some of the TEACH-PD products available.


Since returning how have you been disseminating/implementing your findings?
 

In 2010, I established the HOME Network concept with support from industry partners who provided funding for workshops and activities. The HOME Network is a national initiative that brings together a solution-focused group of home dialysis healthcare professionals from across Australia & New Zealand. The group draws upon all levels of evidence to provide insights and practical options for colleagues to facilitate a positive change towards increased use of home-based dialysis.

In 2012, with the knowledge and experience from the Churchill Fellowship, I further enhanced what was already in place with the HOME Network members, successfully achieving a few significant milestones. One major recent success, in collaboration with partners from Australia and New Zealand (ANZ), was to be awarded funding of over $4M. This funding will be used to complete the development of a "train the trainer" curriculum (first in the world) for home-based Peritoneal Dialysis trainers and patients, also to complete a feasibility study and to commence a Cluster Randomised Controlled Trial (CRCT) in ANZ. The increase in the awareness of home-based dialysis and the evidence from these studies will no doubt improve the uptake and retention of patients on home-based dialysis. This will also improve the experience for the trainers and the patients.

(Above) Josephine Chow delivering TEACH-PD in Cairns in July 2019.


Has your focus changed since going on your Fellowship? If so, how?

Not at all. I am as passionate about this work as at the beginning of the Fellowship journey.


How have your ideas been received by the key stakeholders in your field? Any major challenges?
 

It has taken baby steps to reach the goals I have set, there has been lots of back and forth but eventually we have gotten there. These ideas have taken off and are well received by key stakeholders and funding bodies including; the National Health and Medical Research Council (NHMRC) in Australia and Health Research Council (HRC) in New Zealand, the national international Peak bodies such as the International Society of Peritoneal Dialysis (ISPD) and the Australasian Kidney Trials Network (AKTN). 

To date, the Trial Steering Committee has secured 28 PD units (58%) in Australia and 11 PD Units (100%) in New Zealand to participate in the 44 sites for the Cluster Randomised Controlled Trials. Our ethics application was approved for ANZ sites and 7 sites have been activated with patient recruitment in progress. The TEACH-PD (A Targeted Education ApproaCH to improve Peritoneal Dialysis) trial is formally underway. We are also working with interested parties in Canada and the United Kingdom regarding their participation and funding in these trials. This is really shaping up to be a global initiative and I can see more sites promoting home-based dialysis to more patients.

What is next for you? 

I have always had a passion for home dialysis. As an ambassador for the Churchill Fellows, I am extremely excited about opportunities to ‘make a difference’. I always remember the famous quote from Winston Churchill: “Never give up on something that you can't go a day without thinking about” – that’s how I feel about home dialysis and the work of the HOME Network.

Of course, then there is his inspirational quote, “Success is the ability to go from failure to failure without losing your enthusiasm.” Sure, there have been challenges along the Network’s journey – however, today we continue to grow stronger and we’re still here working hard to make a difference.

I would like to increase the impact of my passion via the work from the HOME Network and also my personal profile.  I believe the impact and awareness will enhance my passion and also promote the Churchill Trust.


What do you hope to achieve in home-based dialysis in the next year or the next 5 years?

I hope to complete the TEACH-PD trial by 2021/22 and that the results continue to enhance my vision to improve the survival of patients on home-based dialysis.

(Above) Josephine presenting at the International Society for Peritoneal Dialysis in South Korea in 2015


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