March 29, 2012

House calls can help bridge disparities gap: speaker

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Following his lecture last week, Harvard’s James Rodrigue, Ph.D., second from right, talks with, from left, Heidi Schaefer, M.D., David Shaffer, M.D., and Hal Helderman, M.D. (photo by Anne Rayner)

House calls can help bridge disparities gap: speaker

James Rodrigue, Ph.D., wants to address the disparities that exist among minorities with chronic kidney disease. He has found taking an old-fashioned approach just might be the answer.

For nearly a decade Rodrigue, associate professor of Psychiatry at Harvard Medical School, has been interested in not only how educational information is disseminated to minority populations, but where it is shared.

Rodrigue is also the director of the Center for Transplant Outcomes and Quality Improvement and the director of Behavioral Health Services and Research at the Transplant Institute at Beth Israel Deaconess Medical Center in Boston.

“Old-Fashioned House Calls: Can They Reduce Disparities in Live Donor Kidney Transplantation?” was the address he presented at the Vanderbilt Transplant Center Research Lecture Series last week.

“When a patient has a clinic appointment in the transplant center, typically they come alone or they might come with a spouse or one other person,” said Rodrigue. “From my perspective, that is not enough. We need to reach many more people in the patients’ circle of family and friends if we are going to be successful.

“Making house calls is not a novel idea, but it is taking that concept and giving it new life.”

According to Rodrigue, studies have shown that patients who receive house calls were more likely to discuss the possibility of live donor kidney transplantation with family and friends.

His current study, a randomized trial to reduce the disparity in live donor kidney transplantation, is funded by the National Institutes of Health. In the trial, patients were randomized to three groups including a standard of care group, which involved education in the clinic setting; a house calls approach, which brought the health team to the family; and a group-based educational session held at the transplant center.

Although the group education model fared better than the standard of care approach, nothing matched the success of the house calls method, he said. On many occasions 10-25 people attended the home sessions, which are proving to be a successful tool.

“Going to a patient’s home changes the dynamics between the patient and the transplant center in a positive way,” he said. “Patients love it and feel a better connection to the center.

“We are able to address issues as part of this effort to ease the patient’s fears about transplant in a setting that is familiar and safe for them. We are not only empowering the patient, but their entire support network.”

In nine years, Rodrigue’s team has completed more than 150 house calls at two different transplant centers. Plans call to collaborate with transplant centers across the United States as well as overseas in the coming months.

He is tracking three primary outcomes: does anyone from the patient’s support system call the transplant center to inquire about living donor transplants?; does the patient have anyone to initiate an evaluation for living donor donation?; and did the patient receive a living donor kidney transplant?

“It has been our experience that the percentage of patients receiving a house call had superior outcomes along all three of these dimensions,” he said.

“It’s common sense — if we can connect with more people in the patient’s life, we will have more benefit. This could go well beyond transplantation.”