Accessing hemodialysis clinics during the COVID-19 pandemic

Abstract

Transportation is a key element of access to healthcare. The COVID-19 pandemic posed unique and unforeseen challenges to patients receiving hemodialysis who rely on three times weekly transportation to receive their life-saving treatments, but there is little data on the problems they faced. This study explores the attitudes, fears, and concerns of hemodialysis patients during the pandemic with a focus on their travel to/from dialysis treatments. A mixed methods travel survey was distributed to hemodialysis patients from three urban centers in Montréal, Canada, during the pandemic (n= 43). The survey included closed questions that were analysed through descriptive statistics as well as open-ended questions that were assessed through thematic analysis. Descriptive statistics show that hemodialysis patients are more fearful of contracting COVID-19 in transit than they are at the treatment center. Patients taking paratransit, public transportation, and taxis are more fearful of COVID-19 while traveling than those who drive, who are driven, or who walk to the clinic. In the open-ended questions, patients reported struggling with confusing COVID-19 protocols in public transport, including conflicting information on whether paratransit taxis allowed one or multiple passengers. Paratransit was the most used travel mode to access treatment (n = 30), with problems identified in the open-ended questions, such as long and unreliable pickup windows, and extended travel times. To limit COVID-19 exposure and stress for paratransit users, agencies should consider sitting one patient per paratransit taxi, clearly communicating COVID-19 protocols online and in the vehicles, and tracking vehicles for more efficient pickups.

Impact of public transport disruption on access to healthcare facility and well-being during the COVID-19 pandemic: A qualitative case study in Metro Manila, Philippines

“… Liu et al (2022) analyzed the influence of containment policies in China on people’s mental health via losses in accessibility. Beaudet et al (2022) sought to understand the concerns and challenges of hemodialysis patients during the pandemic related to their travel to and from treatment. Similarly, Jain and Dupas (2022) studied the indirect effects of the lockdown in India on critical healthcare access and outcomes among low-income dialysis patients.…”

“…From the above-cited studies, we observe that there has indeed been a proliferation of studies investigating the impact of the suspension of public transport operations due to the pandemic on access and well-being. Most of these studies consider either only access impact (e.g., Oluyede et al, 2022 , Palm et al, 2021 , Beaudet et al, 2022 , Verma et al, 2020 , Cochran et al, 2022 , Kar et al, 2022 , Jain and Dupas, 2022 ), or health/well-being impact (e.g., Xiong et al, 2020 , Franklin and Gkiouleka, 2021 ; Mars et al, 2022; Yan et al, 2022 ). Only one study considers the impacts on both access and health/well-being ( Liu et al, 2022 ).…”

Lived Experiences of Patients Receiving Hemodialysis during the COVID-19 Pandemic: A Qualitative Study from the Quebec Renal Network

“…15,16 Very few studies have examined the experiences of in-centre hemodialysis patients during the COVID-19 pandemic. The purpose of this study, which is part of a larger study documenting the impact of COVID-19 hemodialysis clinics in Quebec, 17,18 was to gather hemodialysis patients' perspectives and experiences following the first wave of COVID-19 infections. A better understanding of the scope and magnitude of the disruptions faced by hemodialysis patients during the pandemic would help to inform interventions during public health emergencies.…”

Efficacy of SARS-CoV-2 Vaccination in Dialysis Patients: Epidemiological Analysis and Evaluation of the Clinical Progress

“…Moreover, the reported SARS-CoV-2 seroprevalence is up to 40% in patients on dialysis, even in the presence of the asymptomatic disease [ 5 ]. The elevated infectious risk in these patients can be partly explained by the need for repeated access to hospital/health care facilities, transport from home to the dialysis center and prolonged treatment in contact with other patients and staff [ 6 , 7 ]. The common presence of cardiovascular comorbidity, overweight, diabetes, associated with inflammation, accelerated immunosenescence and ultimately age-related immune dysfunction is another underlying cause for the unfavorable outcomes [ 8 ].…”