Dialysis attendance patterns and health care utilisation of Aboriginal patients attending dialysis services in urban, rural and remote locations

Abstract

Background Aboriginal people in the Northern Territory (NT) suffer the heaviest burden of kidney failure in Australia with most living in remote areas at time of dialysis commencement. As there are few dialysis services in remote areas, many Aboriginal people are required to relocate often permanently, to access treatment. Missing dialysis treatments is not uncommon amongst Aboriginal patients but the relationship between location of dialysis service and dialysis attendance (and subsequent hospital use) has not been explored to date. Aim To examine the relationships between location of dialysis service, dialysis attendance patterns and downstream health service use (overnight hospital admissions, emergency department presentations) among Aboriginal patients in the NT. Methods Using linked hospital and dialysis registry datasets we analysed health service activity for 896 Aboriginal maintenance dialysis patients in the NT between 2008 and 2014. Multivariate linear regression and negative binomial regression analyses explored the associations between dialysis location, dialysis attendance and health service use. Results We found missing two or more dialysis treatments per month was more likely for Aboriginal people attending urban services and this was associated with a two-fold increase in the rate of hospital admissions and more than three-fold increase in ED presentations. However, we found higher dialysis attendance and lower health service utilisation for those receiving care in rural and remote settings. When adjusted for age, time on dialysis, region, comorbidities and residence pre-treatment, among Aboriginal people from remote areas, those dialysing in remote areas had lower rates of hospitalisations (IRR 0.56; P < 0.001) when compared to those who relocated and dialysed in urban areas. Conclusion There is a clear relationship between the provision and uptake of dialysis services in urban, rural and remote areas in the NT and subsequent broader health service utilisation. Our study suggests that the low dialysis attendance associated with relocation and care in urban models for Aboriginal people can potentially be ameliorated by access to rural and remote models and this warrants a rethinking of service delivery policy. If providers are to deliver effective and equitable services, the full range of intended and unintended consequences of a dialysis location should be incorporated into planning decisions.

Haemodialysis patient's adherence to treatment: Relationships among nurse–patient‐initiated participation and nurse's attitude towards patient participation

“…The present study found that haemodialysis patients tend to shorten treatment times by about 20 min on average, supporting previous studies that found patients shorten treatment times by more than 10 min (Al Salmi et al, 2018; Gorham et al, 2022; Saran et al, 2003; Sousa et al, 2019). This finding is concerning, because according to many studies in the field, adherence to haemodialysis is critical to overall treatment effectiveness, and failure to adhere to treatment can lead to poor therapeutic outcomes and increased financial costs (Kammerer et al, 2007).…”

Hemodiálisis en unidades satélites en la provincia de Ourense. Análisis de supervivencia 1986-2018

“…Una limitación de este estudio, debido a las variables disponibles para el análisis, es la imposibilidad de modelizar la función de riesgo para comprobar el efecto de la comorbilidad de los pacientes, así como estudiar la calidad de vida y realizar un análisis de coste-eficiencia. Los datos bibliográficos existentes muestran que la US en áreas urbanas son más coste-eficientes que las situadas de áreas rurales muy alejadas del centro terciario 37 , pero cuando se ajusta por variables como la edad, la comorbilidad o tiempo de permanencia en HD, las unidades eficientes son la US rurales 38 . Una alternativa a las US rurales sería la HD domiciliaria.…”

Unravelling the possibilities: a cross-over randomised controlled feasibility trial on immersive virtual reality in haemodialysis

“…2 Townsville Renal Service, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD 4814, Australia. 3 College of Science and Engineering, James Cook University, Nguma-Bada Campus, PO Box 6811, Cairns, QLD 4870, Australia. 4 Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125, Australia.…”

“…Consequently, many patients have had to relocate from their rural or remote communities to more densely populated cities to access dialysis treatment. Geographical access to haemodialysis has been shown to affect attendance at scheduled dialysis sessions, [2] particularly for First Nations Australians [3]. First Nations Australians comprise 9.04% of the total population within the Townsville Hospital and Health Service.…”

“…Attendance at haemodialysis sessions and adherence to fluid allowances between sessions is vital to patients with end-stage kidney disease [13]. Research shows that First Nations Australians were more likely to miss two or more treatments per month, leading to double the rate of hospital admissions and triple the rate of emergency department presentations compared to their non-Indigenous counterparts [3]. Facilitators of adherence to treatment regimen have been identified as perceived health benefits, self-efficacy and purpose in life [14].…”