Effects of health service geographic accessibility in patients with treated end stage kidney disease: Cohort study 2000–2010

Kotwal, Sradha; Gallagher, Martin; Cass, Alan; Webster, Angela C

doi:10.1111/nep.12913

Cited by 5 publications

(11 citation statements)

References 18 publications

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“…We found 23.9% of Australian RRT patients between 2005 and 2015 relocated, with a relocation incidence of 7.9 per 100 patient years. The proportion is higher than previous estimates of 5%, found in New South Wales in Australia [17], and 15%, calculated from the difference in age adjusted dialysis prevalence for urban vs rural areas in a Japanese prefecture [4]. The increased proportion in our analysis likely resulted from including relocation within same remoteness of residence index and examining a national registry over a 10-year period.…”

Section: Discussioncontrasting

confidence: 75%

“…Australian rural patients with chronic diseases undergo fewer diagnostic or therapeutic interventions compared to urban centres, [10,[19][20][21][22][23] highlighting an inequality in the provision of health services. This extends to rural RRT patients who have a lower health service utilisation, physician visits and proportion of dialysis care [4,5,12,17]. Australian RRT patients in regional districts, compared to major cities, have a lower survival and higher risk of hospitalisation [12,17] while transplant patients in major cities are less likely to have an acute rejection in the first 6 months post-transplant [12].…”

Section: Discussionmentioning

confidence: 99%

“…This extends to rural RRT patients who have a lower health service utilisation, physician visits and proportion of dialysis care [4,5,12,17]. Australian RRT patients in regional districts, compared to major cities, have a lower survival and higher risk of hospitalisation [12,17] while transplant patients in major cities are less likely to have an acute rejection in the first 6 months post-transplant [12]. While we found the absolute number of relocations from rural areas to be low when compared to urban centres it does highlight the greater burden which RRT patients experience in these regions.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and factors associated with geographical relocation in patients receiving renal replacement therapy

2020

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Background: Renal replacement therapy (RRT) places a burden on patients, and geographical relocation for easier access to healthcare facilities is a necessity for some. Incidence and factors associated with relocation has not been comprehensively examined at a national level. We aimed to determine proportion, incidence, characteristics of RRT patients who relocate and relocation rate by remoteness of residence and dialysis modality. Methods: Retrospective cohort analysis using Australian and New Zealand Dialysis and Transplant Registry to examine RRT patients in Australia from January 2005 to December 2015. Relocation incidence was calculated for remoteness of residence and RRT modality as rate per 100 patient years. Factors associated with relocation were examined using competing risk regression models with death as a competing event. Results: Of 24,676 incident patients on RRT, 5888 (23.9%) relocated with a median time of 1.6 years [IQR 0.7-3.4] years. Relocation incidence was 7.9 per 100 patient years and increased from major cities to very remote regions (7.2 to 48.8 per 100 patient years respectively, p < 0.001). Remoteness of residence was associated with geographical relocation in competing risk analysis especially in remote (SHR 1.20, 95%CI 1.01, 1.41 p = 0.034) and very remote regions (SHR 3.51 95% 3.05, 4.04 p < 0.001). Aboriginal or Torres Strait Islander ethnicity, compared to Caucasian, was independently associated with relocation (SHR 1.18, 95% CI 1.06,1.31, p = 0.002) while transplant patients were less likely to relocate compared to haemodialysis patients (HR 0.37, 95%CI 0.34, 0.39, p < 0.001). Conclusions: Relocation in patients receiving RRT is associated with remoteness of residence, RRT modality and ethnicity. Reasons for relocation and its impact on patient wellbeing and outcome should be further explored.

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Section: Discussioncontrasting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incidence and factors associated with geographical relocation in patients receiving renal replacement therapy

2020

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“…People in rural communities encounter many unique and profound barriers to receiving treatment for chronic kidney disease (CKD) that contribute to the increased risk of mortality, morbidity, and hospitalization in this population [1][2][3][4][5][6] . Limited availability of primary care and specialist services in rural communities can lead to late referral to a nephrologist, increased need to relocate for treatment, and inability to access treatment 4,7,8 .…”

Section: Introductionmentioning

confidence: 99%

Patients’ Perspectives on Access to Dialysis and Kidney Transplantation in Rural Communities in Australia

Scholes‐Robertson

Gutman

Howell

et al. 2022

Kidney International Reports

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“…1 2 People with chronic kidney disease (CKD) requiring kidney replacement therapy in rural communities have a higher risk of mortality, morbidity, hospitalisation and a higher burden of disease compared with people in urban locations, though the rates vary depending on modality, degree of remoteness and country. [2][3][4][5][6][7][8][9][10] Access to all forms of dialysis and kidney transplantation for rural patients can be challenging due to late referral and limited local availability of specialist nephrology services. 4 11-14 As a consequence, rural patients are less likely to be placed on the transplant waiting list (8%-15%) than those in urban areas and more likely to use peritoneal dialysis or incentre haemodialysis initially.…”

Section: Introductionmentioning

confidence: 99%

Clinicians’ perspectives on equity of access to dialysis and kidney transplantation for rural people in Australia: a semistructured interview study

et al. 2022

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ObjectivesPeople with chronic kidney disease requiring dialysis or kidney transplantation in rural areas have worse outcomes, including an increased risk of hospitalisation and mortality and encounter many barriers to accessing kidney replacement therapy. We aim to describe clinicians’ perspectives of equity of access to dialysis and kidney transplantation in rural areas.DesignQualitative study with semistructured interviews.Setting and participantsTwenty eight nephrologists, nurses and social workers from 19 centres across seven states in Australia.ResultsWe identified five themes: the tyranny of distance (with subthemes of overwhelming burden of travel, minimising relocation distress, limited transportation options and concerns for patient safety on the roads); supporting navigation of health systems (reliance on local champions, variability of health literacy, providing flexible models of care and frustrated by gatekeepers); disrupted care (without continuity of care, scarcity of specialist services and fluctuating capacity for dialysis); pervasive financial distress (crippling out of pocket expenditure and widespread socioeconomic disadvantage) and understanding local variability (lacking availability of safe and sustainable resources for dialysis, sensitivity to local needs and dependence on social support).ConclusionsClinicians identified geographical barriers, dislocation from homes and financial hardship to be major challenges for patients in accessing kidney replacement therapy. Strategies such as telehealth, outreach services, increased service provision and patient navigators were suggested to improve access.

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Effects of health service geographic accessibility in patients with treated end stage kidney disease: Cohort study 2000–2010

Abstract: Rural residents receiving RRT have higher hospitalization rates, markedly higher rates of IHT and higher long-term mortality compared with their urban counterparts.

Cited by 5 publications

References 18 publications

Incidence and factors associated with geographical relocation in patients receiving renal replacement therapy

Incidence and factors associated with geographical relocation in patients receiving renal replacement therapy

Patients’ Perspectives on Access to Dialysis and Kidney Transplantation in Rural Communities in Australia

Clinicians’ perspectives on equity of access to dialysis and kidney transplantation for rural people in Australia: a semistructured interview study

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