1
|
Taha A, Iman Y, Hingwala J, Askin N, Mysore P, Rigatto C, Bohm C, Komenda P, Tangri N, Collister D. Patient Navigators for CKD and Kidney Failure: A Systematic Review. Kidney Med 2022; 4:100540. [PMID: 36185707 PMCID: PMC9516458 DOI: 10.1016/j.xkme.2022.100540] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Rationale & Objective To what degree and how patient navigators improve clinical outcomes for patients with chronic kidney disease (CKD) and kidney failure is uncertain. We performed a systematic review to summarize patient navigator program design, evidence, and implementation in kidney disease. Study Design A search strategy was developed for randomized controlled trials and observational studies that evaluated the impact of navigators on outcomes in the setting of CKD and kidney failure. Articles were identified from various databases. Two reviewers independently screened the articles and identified those meeting the inclusion criteria. Setting & Participants Patients with CKD or kidney failure (in-center hemodialysis, peritoneal dialysis, home hemodialysis, or kidney transplantation). Selection Criteria for Studies Studies that compared patient navigators with a control, without limits on size, duration, setting, or language. Studies focusing solely on patient education were excluded. Data Extraction Data were abstracted from full texts and risk of bias was assessed. Analytical Approach No meta-analysis was performed. Results Of 3,371 citations, 17 articles met the inclusion criteria including 14 original studies. Navigators came from various healthcare backgrounds including nursing (n=6), social worker (n=2), medical interpreter (n=1), research (n=1), and also included kidney transplant recipients (n=2) and non-medical individuals (n=2). Navigators focused mostly on education (n=9) and support (n = 6). Navigators were used for patients with CKD (n=5), peritoneal dialysis (n=2), in-center hemodialysis (n=4), kidney transplantation (n=2), but not home hemodialysis. Navigators improved transplant workup and listing, peritoneal dialysis utilization, and patient knowledge. Limitations Many studies did not show benefits across other outcomes, were at a high risk of bias, and none reported cost-effectiveness or patient-reported experience measures. Conclusions Navigators improve some health outcomes for CKD but there was heterogeneity in their structure and function. High-quality randomized controlled trials are needed to evaluate navigator program efficacy and cost-effectiveness.
Collapse
|
2
|
Bamforth RJ, Beaudry A, Ferguson TW, Rigatto C, Tangri N, Bohm C, Komenda P. Costs of Assisted Home Dialysis: A Single-Payer Canadian Model From Manitoba. Kidney Med 2021; 3:942-950.e1. [PMID: 34939003 PMCID: PMC8664694 DOI: 10.1016/j.xkme.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale & Objective The prevalence of kidney failure is increasing globally. Most of these patients will require life-sustaining dialysis at a substantial cost to the health care system. Assisted peritoneal dialysis (PD) and assisted home hemodialysis (HD) are potential alternatives to in-center HD and have demonstrated equivalent outcomes with respect to mortality and morbidity. We aim to describe the costs associated with assisted continuous cycling PD (CCPD) and assisted home HD. Study Design Cost minimization model. Setting & Population Adult incident maintenance dialysis patients in Manitoba, Canada. Intervention Full- and partial-assist home HD and CCPD. Full-assist modalities were defined as nurse-assisted dialysis setup and takedown performed by a health care aide, whereas partial-assist modalities only included nurse-assisted setup. Additionally, full-assist home HD was evaluated under a complete care scenario with the inclusion of a health care aide remaining with the patient throughout the duration of treatment. Outcomes Annual per-patient maintenance and training costs related to assisted and self-care home HD and CCPD, presented in 2019 Canadian dollars. Model, Perspective, & Time Frame This model took the perspective of the Canadian public health payer using a 1-year time frame. Results Annual total per-patient maintenance (and training) costs by modality were the following: full-assist CCPD, $75.717 (initial training costs, $301); partial-assist CCPD, $67,765 ($4,385); full-assist home HD, $47,862 ($301); partial-assist home HD, $44,650 ($14,813); and full-assist home HD (complete care), $64,659 ($301). Limitations This model did not account for costs taken from the societal perspective or costs related to PD failure and modality switching. Additionally, this analysis reflects only costs experienced by a single center. Conclusions Assisted home-based dialysis modalities are viable treatment options for patients from a cost perspective. Future studies to consider graduation rates to full self-care from assisted dialysis and the cost implications of respite care are needed.
Collapse
Affiliation(s)
- Ryan J Bamforth
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
| | - Alain Beaudry
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thomas W Ferguson
- Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada.,Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Claudio Rigatto
- Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada.,Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada.,Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Clara Bohm
- Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada.,Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Komenda
- Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada.,Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
3
|
Trachtenberg AJ, Goldberg A. Patients with kidney failure who cannot access dialysis in rural and remote areas of Canada should be prioritized for kidney transplantation. CMAJ 2021; 193:E1772-E1773. [PMID: 34810166 PMCID: PMC8608455 DOI: 10.1503/cmaj.211020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Aaron J Trachtenberg
- Department of Medicine (Trachtenberg) and of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man.
| | - Aviva Goldberg
- Department of Medicine (Trachtenberg) and of Pediatrics and Child Health (Goldberg), University of Manitoba, Winnipeg, Man
| |
Collapse
|
4
|
Evangelidis N, Sautenet B, Manera KE, Howell M, Craig JC, Viecelli AK, O'Lone E, Scholes‐Robertson N, Johnson DW, Cho Y, Tomson C, Wheeler DC, Tong A. Perspectives on blood pressure by patients on haemo‐ and peritoneal dialysis. Nephrology (Carlton) 2020; 26:62-69. [DOI: 10.1111/nep.13775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/01/2020] [Accepted: 08/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
| | - Benedicte Sautenet
- Service de Néphrologie, Hôpital Bretonneau, CHRU Tours, Université de Tours et Nantes, SPHERE‐ INSERM 1246 Tours France
| | - Karine E. Manera
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
| | - Jonathan C. Craig
- College of Medicine and Public Health, Flinders University Adelaide Australia
| | - Andrea K. Viecelli
- Department of Nephrology Princess Alexandra Hospital Brisbane Queensland Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland Brisbane Queensland Australia
| | - Emma O'Lone
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
| | - Nicole Scholes‐Robertson
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
| | - David W. Johnson
- Department of Nephrology Princess Alexandra Hospital Brisbane Queensland Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland Brisbane Queensland Australia
- Translational Research Institute Brisbane Queensland Australia
| | - Yeoungjee Cho
- Department of Nephrology Princess Alexandra Hospital Brisbane Queensland Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland Brisbane Queensland Australia
- Translational Research Institute Brisbane Queensland Australia
| | | | | | - Allison Tong
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
| | | |
Collapse
|
5
|
Jeffs L, Jamieson T, Saragosa M, Mukerji G, Jain AK, Man R, Desveaux L, Shaw J, Agarwal P, Hensel JM, Maione M, Onabajo N, Nguyen M, Bhatia R. Uptake and Scalability of a Peritoneal Dialysis Virtual Care Solution: Qualitative Study. JMIR Hum Factors 2019; 6:e9720. [PMID: 30990460 PMCID: PMC6488957 DOI: 10.2196/humanfactors.9720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 11/29/2018] [Accepted: 01/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background Early research in the area of virtual care solutions with peritoneal dialysis (PD) patients has focused on evaluating the outcomes and impact of these solutions. There has been less attention focused on understanding the factors influencing the uptake, usability, and scalability of virtual care for chronic kidney disease (CKD) patients receiving PD at home. Objective In this context, a study was undertaken to (1) assess and understand the factors influencing the uptake of a virtual care solution and (2) provide recommendations for the scalability of a virtual care solution aimed at enhancing CKD patients’ outcomes and experiences. Methods This study used a qualitative design with semistructured interviews and a thematic analysis approach. A total of 25 stakeholders—6 patients and 3 caregivers, 6 health care providers, 2 vendors, and 8 health system decision makers—participated in this study. Results The following three primary mechanisms emerged to influence the usability of the virtual care solution: (1) receiving hands-on training and ongoing communication from a supportive team, (2) adapting to meet user needs and embedding them into workflow, and (3) being influenced by patient and caregiver characteristics. Further, two overarching recommendations were developed for considerations around scalability: (1) co-design locally, embed into the daily workflow, and deploy over time and (2) share the benefits and build the case. Conclusions Study findings can be used by key stakeholders in their future efforts to enhance the implementation, uptake, and scalability of virtual care solutions for CKD and managing PD at home.
Collapse
Affiliation(s)
- Lianne Jeffs
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Trevor Jamieson
- St. Michael's Hospital, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Marianne Saragosa
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Geetha Mukerji
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Arsh K Jain
- London Health Sciences Centre, London, ON, Canada
| | - Rachel Man
- London Health Sciences Centre, London, ON, Canada
| | - Laura Desveaux
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - James Shaw
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Payal Agarwal
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer M Hensel
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | | | - Nike Onabajo
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Megan Nguyen
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - R Bhatia
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| |
Collapse
|
6
|
Beaudry A, Ferguson TW, Rigatto C, Tangri N, Dumanski S, Komenda P. Cost of Dialysis Therapy by Modality in Manitoba. Clin J Am Soc Nephrol 2018; 13:1197-1203. [PMID: 30021819 PMCID: PMC6086697 DOI: 10.2215/cjn.10180917] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 05/14/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The prevalence of ESKD is increasing worldwide. Treating ESKD is disproportionately costly in comparison with its prevalence, mostly due to the direct cost of dialysis therapy. Here, we aim to provide a contemporary cost description of dialysis modalities, including facility-based hemodialysis, peritoneal dialysis, and home hemodialysis, provided with conventional dialysis machines and the NxStage System One. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We constructed a cost-minimization model from the perspective of the Canadian single-payer health care system including all costs related to dialysis care. The labor component of costs consisted of a breakdown of activity-based per patient direct labor requirements. Other costs were taken from statements of operations for the kidney program at Seven Oaks General Hospital (Winnipeg, Canada). All costs are reported in Canadian dollars. RESULTS Annual maintenance expenses were estimated as $64,214 for in-center facility hemodialysis, $43,816 for home hemodialysis with the NxStage System One, $39,236 for home hemodialysis with conventional dialysis machines, and $38,658 for peritoneal dialysis. Training costs for in-center facility hemodialysis, home hemodialysis with the NxStage System One, home hemodialysis with conventional dialysis machines, and peritoneal dialysis are estimated as $0, $16,143, $24,379, and $7157, respectively. The threshold point to achieve cost neutrality was determined to be 9.7 months from in-center hemodialysis to home hemodialysis with the NxStage System One, 12.6 months from in-center hemodialysis to home hemodialysis with conventional dialysis machines, and 3.2 months from in-center hemodialysis to peritoneal dialysis. CONCLUSIONS Home modalities have lower maintenance costs, and beyond a short time horizon, they are most cost efficient when considering their incremental training expenses. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_07_18_CJASNPodcast_18_8_F.mp3.
Collapse
Affiliation(s)
- Alain Beaudry
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada; and
| | - Thomas W. Ferguson
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada; and
| | - Claudio Rigatto
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada; and
| | - Navdeep Tangri
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada; and
| | - Sandi Dumanski
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Paul Komenda
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada; and
| |
Collapse
|
7
|
Lunney M, Lee R, Tang K, Wiebe N, Bello AK, Thomas C, Rabi D, Tonelli M, James MT. Impact of Telehealth Interventions on Processes and Quality of Care for Patients With ESRD. Am J Kidney Dis 2018; 72:592-600. [PMID: 29699884 DOI: 10.1053/j.ajkd.2018.02.353] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/11/2018] [Indexed: 12/11/2022]
Abstract
Caring for patients with end-stage renal disease (ESRD) requiring dialysis is intensive and expensive. Telehealth may improve the access and efficiency of ESRD care. For this perspective, we systematically reviewed studies that examined the effectiveness of telehealth versus or in addition to usual care for ESRD management. 10 studies were identified, including 7 randomized trials and 3 cohort studies. Study populations, modes of delivery (including telephone, telemetry, or videoconferencing), and the outcomes evaluated varied substantially between studies. Two studies examined telehealth interventions versus standard ESRD care and demonstrated mixed results on processes of care, no differences in laboratory surrogate markers of ESRD care, and reduced or similar rates of hospitalization. Eight studies evaluated the addition of telehealth to usual care and demonstrated no significant improvements in processes of care or surrogate laboratory measures, variable impacts on hospitalization rates, and mixed impacts on some domains of quality of life, including improvement in mental health. Although potential benefits of telehealth in ESRD care have been reported, optimal designs for delivery and elements of care that may be improved through telehealth remain uncertain.
Collapse
Affiliation(s)
- Meaghan Lunney
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Raymond Lee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Karen Tang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Chandra Thomas
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Doreen Rabi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Marcello Tonelli
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Matthew T James
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| |
Collapse
|
8
|
Screening for chronic kidney disease in Canadian indigenous peoples is cost-effective. Kidney Int 2017; 92:192-200. [PMID: 28433383 DOI: 10.1016/j.kint.2017.02.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/23/2017] [Accepted: 02/02/2017] [Indexed: 01/02/2023]
Abstract
Canadian indigenous (First Nations) have rates of kidney failure that are 2- to 4-fold higher than the non-indigenous general Canadian population. As such, a strategy of targeted screening and treatment for CKD may be cost-effective in this population. Our objective was to assess the cost utility of screening and subsequent treatment for CKD in rural Canadian indigenous adults by both estimated glomerular filtration rate and the urine albumin-to-creatinine ratio. A decision analytic Markov model was constructed comparing the screening and treatment strategy to usual care. Primary outcomes were presented as incremental cost-effectiveness ratios (ICERs) presented as a cost per quality-adjusted life-year (QALY). Screening for CKD was associated with an ICER of $23,700/QALY in comparison to usual care. Restricting the model to screening in communities accessed only by air travel (CKD prevalence 34.4%), this ratio fell to $7,790/QALY. In road accessible communities (CKD prevalence 17.6%) the ICER was $52,480/QALY. The model was robust to changes in influential variables when tested in univariate sensitivity analyses. Probabilistic sensitivity analysis found 72% of simulations to be cost-effective at a $50,000/QALY threshold and 93% of simulations to be cost-effective at a $100,000/QALY threshold. Thus, targeted screening and treatment for CKD using point-of-care testing equipment in rural Canadian indigenous populations is cost-effective, particularly in remote air access-only communities with the highest risk of CKD and kidney failure. Evaluation of targeted screening initiatives with cluster randomized controlled trials and integration of screening into routine clinical visits in communities with the highest risk is recommended.
Collapse
|