Association between residence location and likelihood of kidney transplantation in Aboriginal patients treated with dialysis in Canada

Tonelli, Marcello; Hemmelgarn, Brenda R.; Kim, A.K.J.; Bertazzon, Stefania; Klarenbach, Scott; Manns, Braden; Wiebe, Natasha; Culleton, Bruce F.; Gill, John S.

doi:10.1038/sj.ki.5001607

Cited by 42 publications

(40 citation statements)

References 22 publications

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“…One Canadian study noted that approximately 24% of chronic dialysis patients live more than 150 km (93 miles) from the nearest available nephrologist (6). Distance from available nephrologists has been associated with poorer health outcomes (7)(8)(9). The goal of any chronic dialysis program is to provide optimal equitable care to all of its patients regardless of location and physician resources.…”

mentioning

confidence: 99%

Model for Equitable Care and Outcomes for Remote Full Care Hemodialysis Units

Bernstein¹,

Zacharias²,

Blanchard

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Remotely located patients not living close to a nephrologist present major challenges for providing care. Various models of remotely delivered care have been developed, with a gap in knowledge regarding the outcomes of these heterogeneous models. This report describes a satellite care model for remote full-care hemodialysis units managed homogenously in the province of Manitoba, Canada, without onsite nephrologists. Survival in remotely located full-care units is compared with a large, urban full-care center with onsite nephrologists.Design, setting, participants, & measurements: Data from a Canadian provincial dialysis registry were extracted on 2663 patients between 1990 and 2005. All-cause mortality after initiation of chronic hemodialysis was assessed with Cox proportional hazards regression. Both short-term (1 year) and long-term (2 to 5 years) survival were analyzed.Results: Survival for patients receiving remotely delivered care was shown to be better than for those receiving care in the urban care center with this particular Canadian model of care. Furthermore, there was no difference when assessing short-and long-term survival. This was independent of distance from the urban center.Conclusions: Chronic hemodialysis patients receiving remotely delivered care in a specialized facility attain comparable, if not better survival outcomes than their urban counterparts with direct onsite nephrology care. This model can potentially be adapted to other underserviced areas, including increasingly larger urban centers.

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confidence: 99%

Model for Equitable Care and Outcomes for Remote Full Care Hemodialysis Units

Bernstein¹,

Zacharias²,

Blanchard

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…Assuming that improving access to nephrology care by reducing travel time would lead to improved outcomes and lower hospitalization rates, as suggested by observational studies (1)(2)(3)(4)(5)(6)(7)(8)(9), establishing this additional clinic would represent good value for money, with ICURs ranging from $4000 to $8000/QALY in most scenarios. However, if reducing distance to specialized care does not reduce the risk of hospitalization or mortality, the cost-effectiveness of establishing a new clinic may be considerably less attractive-although it still might be economically attractive by current standards.…”

Section: Discussionmentioning

confidence: 99%

“…Although kidney disease occurs throughout the province, specialized renal care is provided in 17 clinics that are predominantly located in the more densely populated southern half of Alberta ( Figure 1). Multiple studies (1)(2)(3)(4)(5)(6)(7)(8)(9) have shown that distance from health services is inversely associated with clinical benefits. We recently showed (10) that markers of good-quality care in CKD patients in Alberta decreased with increasing distance from the practice location of the closest nephrologist.…”

Section: Introductionmentioning

confidence: 99%

Adding Specialized Clinics for Remote-Dwellers with Chronic Kidney Disease

Wiebe

Klarenbach

Chui

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives This study aimed to determine whether opening a new clinic in a remote region would be a cost-effective means of improving care for remote-dwellers with CKD.Design, setting, participants, & measurements This study is a cost-utility analysis from a public payer's perspective over a lifetime horizon, using administrative data from a large cohort of adults with stage 3b-4 CKD in Alberta, Canada. The association between the distance from each simulated patient's residence and the practice location of the closest nephrologist and clinical outcomes (quality of care, hospitalization, dialysis, and death) were examined. A Markov 6-month cycle economic decision model was analyzed; estimates of the effect of a new clinic were based on the association between residence location, resource use, and outcomes. Costs are reported in 2009 Canadian dollars.Results The costs for equipping and operating a clinic for 321 remote-dwelling patients were estimated at $25,000 and $250,000/yr, respectively. The incremental cost-utility ratios (ICURs) ranged from $4000 to $8000/qualityadjusted life-year under most scenarios. However, if reducing distance to nephrologist care does not alter mortality or hospitalization among remote-dwellers, the cost-effectiveness becomes less attractive. All other one-way sensitivity analyses had negligible effects on the ICUR.Conclusions Given the low costs of equipping and operating new clinics, and the very attractive ICUR relative to other currently funded interventions, establishing new clinics for remote-dwellers could play an important role in efficiently improving outcomes for patients with CKD. High-quality controlled studies are required to confirm this hypothesis.

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“…The last decade has witnessed increased use of geographic information systems (GIS) analysis for measuring access to health services and facilities, healthcare utilization, and relationships with healthcare outcomes (6,7,9,12,(21)(22)(23)(24). However, the use of GIS techniques to determine the optimal location of a healthcare facility with the goal of optimizing patient access is limited (12,18,20,25).…”

Section: Introductionmentioning

confidence: 99%

“…Residents of remote communities may experience increased morbidity and mortality because of chronic diseases such as cardiovascular disease, chronic kidney disease (CKD), and cancer (1)(2)(3)(4)(5)(6)(7)(8)(9). Increased travel time to receive specialty care for such illnesses is a potentially reversible determinant of adverse outcomes, and several studies have shown that increased distance between the patient's residence and the closest relevant medical specialist is associated with adverse outcomes (9 -12).…”

Section: Introductionmentioning

confidence: 99%

A Novel Technique to Optimize Facility Locations of New Nephrology Services for Remote Areas

Ayyalasomayajula

Wiebe

Hemmelgarn

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Travel distance to healthcare facilities affects healthcare access and utilization. Using the example of patients with kidney disease and nephrology services, we investigated the feasibility and utility of using geographic information system (GIS) techniques to identify the ideal location for new clinics to improve care for patients with kidney disease, on the basis of systematically minimizing travel time for remote dwellers.Design, setting, participants, & measurements Using a provincial laboratory database to identify patients with kidney disease and where they lived, we used GIS techniques of buffer and network analysis to determine ideal locations for up to four new nephrology clinics. Service-area polygons for different travel-time intervals were generated and used to determine the best locations for the four new facilities that would minimize the number of patients with kidney disease who were traveling Ͼ2 hours. ResultsWe studied 31,452 adults with living in Alberta, Canada. Adding the four new facilities would increase the number of patients living Ͻ30 minutes from a clinic by 2.2% and reduce the number living Ͼ120 minutes away by 72.5%. Different two-and three-clinic scenarios reduced the number of people living Ͼ120 minutes away by as much as 65% or as little as 32%, emphasizing the importance of systematic evaluation.Conclusions GIS techniques are an attractive alternative to the current practice of arbitrarily locating new facilities on the basis of perceptions about patient demand. Optimal location of new clinical services to minimize travel time might facilitate better patient care.

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Association between residence location and likelihood of kidney transplantation in Aboriginal patients treated with dialysis in Canada

Cited by 42 publications

References 22 publications

Model for Equitable Care and Outcomes for Remote Full Care Hemodialysis Units

Model for Equitable Care and Outcomes for Remote Full Care Hemodialysis Units

Adding Specialized Clinics for Remote-Dwellers with Chronic Kidney Disease

A Novel Technique to Optimize Facility Locations of New Nephrology Services for Remote Areas

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