PD LAWTON1, M CHATFIELD1, AMS AHMED1, G GORHAM1, A CASS1
1Renal Unit, Wellbeing & Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
Aim: To examine the chances of Northern Territory (NT) patients receiving renal replacement therapy (RRT) closer to home, by Indigenous status and over time period.
Background: Patients, communities and advocacy groups have called for RRT closer to home in remote Australia for over 20 years. The Dialysis Models of Care (DxMOC) Partnership is a mixed-methods study examining the outcomes and cost of different models of care for patients receiving RRT in the NT.
Methods: Using linked ANZDATA Registry and NT hospitalisations administrative data, all patients who started maintenance RRT between 1 January 2000 and 31 December 2014 were included and followed for up to five years, until 31 December 2015. Models of care over time were based on ANZDATA treatment modality and NT hospital treatment `ward’ and location. Life table methods examined the chances of staying in urban facilities, censored for death; a Cox proportional hazard model examined the effects of ethnicity, comorbidity and time period on the chances of treatment outside urban facilities.
Results: Of 1,142 patients staring RRT during the study period, 928 (836 Indigenous) were still receiving RRT in urban facilities 90 days later and were included. After five years, 310 Indigenous and 29 non-Indigenous patients had left urban facility treatment (p=0.85 by log-rank); more left urban facility treatment in 2009-2014 compared to before 2008 (p<0.001 by log-rank). Compared to those starting RRT before 2005, those starting 2005-8 had a hazard ratio (HR, with 95% confidence intervals) of leaving urban facilities of 1.37 (0.96-1.92), and those starting 2009-14, HR 2.06 (1.53-2.79).
Conclusions: Treatment closer to home has become more likely in recent years in the NT for both Indigenous and non-Indigenous patients.