In‐center hemodialysis attendance: Patient perceptions of risks, barriers, and recommendations

Chenitz, Kara B.; Fernando, Michael B.; Shea, Judy A.

doi:10.1111/hdi.12139

Cited by 26 publications

(38 citation statements)

References 26 publications

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“…And then… coming to pick you up, if you’re not ready when they get there, they will leave you and you’ll have to sit and wait and wait and wait (American patient). 86 It is always in the back of your mind that it (the transplant) will fail, at times. And I think if anything that makes you more inclined to comply with your treatment, comply with your medication because at the end of the day if, you know, if you do the utmost that you can and you take your medicine and you go to your follow up appointments, then there’s hopefully less chance of it failing in the long run (woman, 3 years+post-transplant).…”

Section: Resultsmentioning

confidence: 99%

Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies

et al. 2018

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IntroductionChronic kidney disease (CKD) requires patients and caregivers to invest in self-care and self-management of their disease. We aimed to describe the work for adult patients that follows from these investments and develop an understanding of burden of treatment (BoT).MethodsSystematic review of qualitative primary studies that builds on EXPERTS1 Protocol, PROSPERO registration number: CRD42014014547. We included research published in English, Spanish and Portuguese, from 2000 to present, describing experience of illness and healthcare of people with CKD and caregivers. Searches were conducted in MEDLINE, Embase, CINAHL Plus, PsycINFO, Scopus, Scientific Electronic Library Online and Red de Revistas Científicas de América Latina y el Caribe, España y Portugal. Content was analysed with theoretical framework using middle-range theories.ResultsSearches resulted in 260 studies from 30 countries (5115 patients and 1071 carers). Socioeconomic status was central to the experience of CKD, especially in its advanced stages when renal replacement treatment is necessary. Unfunded healthcare was fragmented and of indeterminate duration, with patients often depending on emergency care. Treatment could lead to unemployment, and in turn, to uninsurance or underinsurance. Patients feared catastrophic events because of diminished financial capacity and made strenuous efforts to prevent them. Transportation to and from haemodialysis centre, with variable availability and cost, was a common problem, aggravated for patients in non-urban areas, or with young children, and low resources. Additional work for those uninsured or underinsured included fund-raising. Transplanted patients needed to manage finances and responsibilities in an uncertain context. Information on the disease, treatment options and immunosuppressants side effects was a widespread problem.ConclusionsBeing a person with end-stage kidney disease always implied high burden, time-consuming, invasive and exhausting tasks, impacting on all aspects of patients' and caregivers’ lives. Further research on BoT could inform healthcare professionals and policy makers about factors that shape patients’ trajectories and contribute towards a better illness experience for those living with CKD.PROSPERO registration numberCRD42014014547.

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Section: Resultsmentioning

confidence: 99%

Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies

et al. 2018

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“…Potential adherence barriers to receiving dialysis care were identified through the review of the dialysis literature [2][3][4] and from studies in the general population such as that by Flores et al, who administered questionnaires focused on barriers to health care to patients. 14 The authors of the study were also free to contribute their own hypotheses drawn from their empirical experiences in clinical practice.…”

Section: Adherence Barriersmentioning

confidence: 99%

“…Several small studies have associated depression, unreliable transportation, demographic factors, and lack of motivation with a missed dialysis treatment; however, a large comprehensive analysis of adherence barriers to dialysis care and their implication on patient outcomes currently remains elusive. [2][3][4] In this study, we identified missed hemodialysis appointments from a large ESRD cohort to quantify their effect on subsequent hospitalizations, emergency room(ER) visits,and intensive-coronarycareunit(ICU-CCU) admissions. We used these results to test which systemic and patient barriers potentially impede patients from getting to their dialysis facility for treatment.…”

Section: Introductionmentioning

confidence: 99%

Adherence Barriers to Chronic Dialysis in the United States

Chan

Thadhani

Maddux

2014

Journal of the American Society of Nephrology

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Hemodialysis patients often do not attend their scheduled treatment session. We investigated factors associated with missed appointments and whether such nonadherence poses significant harm to patients and increases overall health care utilization in an observational analysis of 44 million hemodialysis treatments for 182,536 patients with ESRD in the United States. We assessed the risk of hospitalization, emergency room visit, or intensive-coronary care unit (ICU-CCU) admission in the 2 days after a missed treatment relative to the risk for patients who received hemodialysis. Over the 5-year study period, the average missed treatment rate was 7.1 days per patient-year. In covariate adjusted logistic regression, the risk of hospitalization (odds ratio [OR], 3.98; 95% confidence interval [95% CI], 3.93 to 4.04), emergency room visit (OR, 2.00; 95% CI, 1.87 to 2.14), or ICU-CCU admission (OR, 3.89; 95% CI, 3.81 to 3.96) increased significantly after a missed treatment. Overall, 0.9 missed treatment days per year associated with suboptimal transportation to dialysis, inclement weather, holidays, psychiatric illness, pain, and gastrointestinal upset. These barriers also associated with excess hospitalization (5.6 more events per patient-year), emergency room visits (1.1 more visits), and ICU-CCU admissions (0.8 more admissions). In conclusion, poor adherence to hemodialysis treatments may be a substantial roadblock to achieving better patient outcomes. Addressing systemic and patient barriers that impede access to hemodialysis care may decrease missed appointments and reduce patient morbidity. Timely and unhindered access to preventative services and ambulatory care is an important component of sustaining healthy populations. Without access to these services, patients will experience more hospitalizations and deaths from preventable medical conditions. 1,2 Patients with ESRD who are on chronic hemodialysis typically require three outpatient treatments per week to prevent serious complications from their kidney failure. 2 Yet many patients with ESRD miss their hemodialysis treatment and place themselves at increased risk for hospitalization or mortality. 2 Why patients miss dialysis remains incompletely understood. Several small studies have associated depression, unreliable transportation, demographic factors, and lack of motivation with a missed dialysis treatment; however, a large comprehensive analysis of adherence barriers to dialysis care and their implication on patient outcomes currently remains elusive. [2][3][4] In this study, we identified missed hemodialysis appointments from a large ESRD cohort to quantify their effect on subsequent hospitalizations, emergency room(ER) visits,and intensive-coronarycareunit(ICU-CCU) admissions. We used these results to test which systemic and patient barriers potentially impede patients from getting to their dialysis facility for treatment. RESULTS Treatments Characteristics in the Study PopulationA total of 44,586,241 outpatient hemodialysis treatments from 182,53...

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“…8 Patients from all cultural backgrounds can struggle with adherence to hemodialysis (HD) regimens, with access and family support among barriers and enablers to treatment adherence. 11 Research incorporating the perspectives of patients and their health care providers can inform service improvement and guide culturally appropriate and accessible care for minority cultural groups. [12][13][14] The goal of this study was to inform service improvement based on the insights of consumers and those delivering their treatment and services.…”

Section: Introductionmentioning

confidence: 99%

The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: A qualitative study

Rix

Barclay

Stirling

et al. 2014

Hemodialysis International

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Chronic kidney disease has a higher prevalence in Indigenous populations globally. The incidence of end-stage kidney disease in Australian Aboriginal people is eight times higher than non-Aboriginal Australians. Providing services to rural and remote Aboriginal people with chronic disease is challenging because of access and cultural differences. This study aims to describe and analyze the perspectives of Aboriginal patients' and health care providers' experience of renal services, to inform service improvement for rural Aboriginal hemodialysis patients. We conducted a thematic analysis of interviews with Aboriginal patients (n = 18) receiving hemodialysis in rural Australia and health care providers involved in their care (n = 29). An overarching theme of avoiding the “costly” crisis encompassed four subthemes: (1) Engaging patients earlier (prevent late diagnosis, slow disease progression); (2) flexible family-focused care (early engagement of family, flexibility to facilitate family and cultural obligations); (3) managing fear of mainstream services (originating in family dialysis experiences and previous racism when engaging with government organizations); (4) service provision shaped by culture (increased home dialysis, Aboriginal support and Aboriginal-led cultural education). Patients and health care providers believe service redesign is required to meet the needs of Aboriginal hemodialysis patients. Participants identified early screening and improving the relationship of Aboriginal people with health systems would reduce crisis entry to hemodialysis. These strategies alongside improving the cultural competence of staff would reduce patients' fear of mainstream services, decrease the current emotional and family costs of care, and increase efficiency of health expenditure on a challenging and increasingly unsustainable treatment system.

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In‐center hemodialysis attendance: Patient perceptions of risks, barriers, and recommendations

Cited by 26 publications

References 26 publications

Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies

Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies

Adherence Barriers to Chronic Dialysis in the United States

The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: A qualitative study

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