Geographical variation in the referral of patients with chronic end stage renal failure for renal replacement therapy

Boyle, P.J.; Kudlac, H.; Williams, Astrid-Jane

doi:10.1093/qjmed/89.2.151

Cited by 43 publications

(26 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A great deal of work has been done in previous years to highlight the inequalities in RRT provision in the UK including the contribution of referral patterns -referral rates have been shown to be affected by both the geographical distance from a renal centre [7][8][9][10][11] and the level of resource available for RRT treatment [12]. Despite many recent advances in the provision of renal services in the UK and the now comparable rate of RRT incidence to that in most other Northern European countries [13], non-referral remained a concern amongst the consensus group.…”

Section: Discussionmentioning

confidence: 99%

Chapter 15: UK Renal Centre Survey Results 2010: RRT Incidence and Use of Home Dialysis Modalities

et al. 2011

View full text Add to dashboard Cite

Introduction: RRT incidence rates and the proportion of patients using a home dialysis modality (peritoneal or home haemodialysis) varies widely between centres and persists even after area differences in age, ethnicity and social deprivation structure are taken into account. A nationwide survey was undertaken to identify possible drivers of this variation. Methods: A systematic literature review followed by a two-stage Delphi consensus technique was employed to identify renal centre characteristics and practice patterns that may be important in determining either RRT incidence or home modality usage. Results: All 72 (100%) of UK adult renal centres responded. Questions about staffing numbers, interface with primary care, interface with other secondary care sites, capacity within the HD programme, constituents of pre-dialysis education programmes, conservative management programmes, range of treatments available, dialysis access and training and physician attitudes to home modalities were included. Conclusions: There was wide variation in practice patterns and centre characteristics across the UK. Overall, physician enthusiasm for home dialysis modalities was greater than the actual usage of home dialysis.

show abstract

Section: Discussionmentioning

confidence: 99%

Chapter 15: UK Renal Centre Survey Results 2010: RRT Incidence and Use of Home Dialysis Modalities

et al. 2011

View full text Add to dashboard Cite

show abstract

“…It has been reported that there is an inverse relation of initiation of renal replacement therapy with distance (Roderick et al, 1999) and that referral of patients with ESRD, aged 60 years and over, decrease with distance to the treatment center (Boyle et al, 1996). This fact was confirmed by another study which found that the prevalence of renal replacement therapy fell significantly with longer travel times for dialysis, even when patients lived relatively close to a facility (White et al, 2006).…”

Section: Introductionmentioning

confidence: 84%

Designing a model to minimize inequities in hemodialysis facilities distribution

et al. 2011

View full text Add to dashboard Cite

Abstract. Portugal has an uneven, city-centered bias in the distribution of hemodialysis centers found to contribute to health care inequities. A model has been developed with the aim of minimizing access inequity through the identification of the best possible localization of new hemodialysis facilities. The model was designed under the assumption that individuals from different geographic areas, ceteris paribus, present the same likelihood of requiring hemodialysis in the future. Distances to reach the closest hemodialysis facility were calculated for every municipality lacking one. Regions were scored by aggregating weights of the "individual burden", defined as the burden for an individual living in a region lacking a hemodialysis center to reach one as often as needed, and the "population burden", defined as the burden for the total population living in such a region. The model revealed that the average travelling distance for inhabitants in municipalities without a hemodialysis center is 32 km and that 145,551 inhabitants (1.5%) live more than 60 min away from a hemodialysis center, while 1,393,770 (13.8%) live 30-60 min away. Multivariate analysis showed that the current localization of hemodialysis facilities is associated with major urban areas. The model developed recommends 12 locations for establishing hemodialysis centers that would result in drastically reduced travel for 34 other municipalities, leaving only six (34,800 people) with over 60 min of travel. The application of this model should facilitate the planning of future hemodialysis services as it takes into consideration the potential impact of travel time for individuals in need of dialysis, as well as the logistic arrangements required to transport all patients with end-stage renal disease. The model is applicable in any country and health care planners can opt to weigh these two elements differently in the model according to their priorities.

show abstract

“…A recent study demonstrated that dialysis patients living farther from a renal unit had a lower likelihood of being referred for pre-ESRD nephrology care. 35 Previous studies have also reported poorer performance on dialysis quality measures, including timing of referral to nephrology care in areas with poor socioeconomic status. For example, Australian patients living in urban areas with higher socioeconomic deprivation scores were more likely to be referred late for nephrology care than other patients.…”

Section: Discussionmentioning

confidence: 99%

Racial Composition of Residential Areas Associates with Access to Pre-ESRD Nephrology Care

Prakash¹,

Rodriguez

Austin

et al. 2010

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Referral to a nephrologist before initiation of chronic dialysis occurs less frequently for blacks than whites, but the reasons for this disparity are incompletely understood. Here, we examined the contribution of racial composition by zip code on access and quality of nephrology care before initiation of renal replacement therapy (RRT). We retrospectively studied a cohort study of 92,000 white and black adults who initiated RRT in the United States between June 1, 2005, and October 5, 2006. The percentage of patients without pre-ESRD nephrology care ranged from 30% among those who lived in zip codes with Ͻ5% black residents to 41% among those who lived in areas with Ͼ50% black residents. In adjusted analyses, as the percentage of blacks in residential areas increased, the likelihood of not receiving pre-ESRD nephrology care increased. Among patients who received nephrology care, the quality of care (timing of care and proportion of patients who received a pre-emptive renal transplant, who initiated therapy with peritoneal dialysis, or who had a permanent hemodialysis access) did not differ by the racial composition of their residential area. In conclusion, racial composition of residential areas associates with access to nephrology care but not with quality of the nephrology care received.

show abstract

Geographical variation in the referral of patients with chronic end stage renal failure for renal replacement therapy

Cited by 43 publications

References 9 publications

Chapter 15: UK Renal Centre Survey Results 2010: RRT Incidence and Use of Home Dialysis Modalities

Chapter 15: UK Renal Centre Survey Results 2010: RRT Incidence and Use of Home Dialysis Modalities

Designing a model to minimize inequities in hemodialysis facilities distribution

Racial Composition of Residential Areas Associates with Access to Pre-ESRD Nephrology Care

Contact Info

Product

Resources

About