Advancing a Paradigm Shift to Approaching Health Systems in the Field of Living-Donor Kidney Transplantation: An Opinion Piece

Sandal, Shaifali; Horton, Anna; Fortin, Marie-Chantal

doi:10.1177/20543581221079486

Cited by 7 publications

(11 citation statements)

References 44 publications

(85 reference statements)

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“… 19 - 21 These interventions have had limited impact and may be contributing to transplant inequity. 18 , 22 , 23 This is because it is unrealistic to place the onus of finding a donor on an already overwhelmed and sick patient who has to deal with complex treatment regimens, an approach which can tend to favor those who have the social and financial means to learn to understand this process and seek donors. 23 - 25 Also, individual microlevel approaches fail to address the dynamic processes that are involved in delivering health services to patients.…”

Section: Introductionmentioning

confidence: 99%

“… 18 , 22 , 23 This is because it is unrealistic to place the onus of finding a donor on an already overwhelmed and sick patient who has to deal with complex treatment regimens, an approach which can tend to favor those who have the social and financial means to learn to understand this process and seek donors. 23 - 25 Also, individual microlevel approaches fail to address the dynamic processes that are involved in delivering health services to patients. 26 Although some recent interventions to increase LDKT numbers have demonstrated interest in a more holistic approach to system functioning, 27 there remains little research to address how macrolevels of practice, such as organizations and the environment, influence the delivery of LDKT as a treatment option to patients.…”

Section: Introductionmentioning

confidence: 99%

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Living Donor Kidney Transplantation in Quebec: A Qualitative Case Study of Health System Barriers and Facilitators

Horton

Loban

Fortin

et al. 2023

Can J Kidney Health Dis

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Background: Patients with kidney failure represent a major public health burden, and living donor kidney transplantation (LDKT) is the best treatment option for these patients. Current work to optimize LDKT delivery to patients has focused on microlevel interventions and has not addressed interdependencies with meso and macro levels of practice. Objective: We aimed to learn from a health system with historically low LDKT performance to identify facilitators and barriers to LDKT. Our specific aims were to understand how LDKT delivery is organized through interacting macro, meso, and micro levels of practice and identify what attributes and processes of this health system facilitate the delivery of LDKT to patients with kidney failure and what creates barriers. Design: We conducted a qualitative case study, applying a complex adaptive systems approach to LDKT delivery, that recognizes health systems as being made up of dynamic, nested, and interconnected levels, with the patient at its core. Setting: The setting for this case study was the province of Quebec, Canada. Participants: Thirty-two key stakeholders from all levels of the health system. This included health care professionals, leaders in LDKT governance, living kidney donors, and kidney recipients. Methods: Semi-structured interviews with 32 key stakeholders and a document review were undertaken between February 2021 and December 2021. Inductive thematic analysis was used to generate themes. Results: Overall, we identified strong links between system attributes and processes and LDKT delivery, and more barriers than facilitators were discerned. Barriers that undermined access to LDKT included fragmented LDKT governance and expertise, disconnected care practices, limited resources, and regional inequities. Some were mitigated to an extent by the intervention of a program launched in 2018 to increase LDKT. Facilitators driven by the program included advocacy for LDKT from individual member(s) of the care team, dedicated resources, increased collaboration, and training opportunities that targeted LDKT delivery at multiple levels of practice. Limitations: Delineating the borders of a “case” is a challenge in case study research, and it is possible that some perspectives may have been missed. Participants may have produced socially desirable answers. Conclusions: Our study systematically investigated real-world practices as they operate throughout a health system. This novel approach has cross-disciplinary methodological relevance, and our findings have policy implications that can help inform multilevel interventions to improve LDKT.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Living Donor Kidney Transplantation in Quebec: A Qualitative Case Study of Health System Barriers and Facilitators

Horton

Loban

Fortin

et al. 2023

Can J Kidney Health Dis

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, current, often unidimensional, approaches to increase LDKT have led to modest improvements and some argue are contributing to disparities in access to LDKT. 1,3,[5][6][7][8][9] Overall, there is growing recognition that efforts to increase LDKT should include a comprehensive system-level approach to understanding and addressing barriers and inefficiencies that patients and their donors face. 1,2,[10][11][12][13][14][15] Investigating current health systems with variable LDKT rates and understanding factors that drive these differences may provide rich insights into these system-level barriers and inefficiencies.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, current and often unidimensional approaches to increase LDKT have led to modest improvements, and some argue, are contributing to disparities in access to LDKT. 1 , 3 , 5 , 6 , 7 , 8 , 9 Overall, there is growing recognition that efforts to increase LDKT should include a comprehensive system-level approach to understanding and addressing barriers and inefficiencies that patients and their donors face. 1 , 2 , 3 , 10 , 11 , 12 , 13 , 14 …”

mentioning

confidence: 99%

“… 14 , 20 However, HPs are also an integral part of health systems. They are known to play an important role in improving access and quality of care delivered to patients, 8 , 21 and may provide unique insights into system-level inefficiencies that impede LDKT. We previously conducted an interpretive descriptive study of HPs from 3 Canadian provinces with variable LDKT performance.…”

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confidence: 99%

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