N SCHOLES-ROBERTSON1, T GUTMAN1, M HOWELL1, J CRAIG2, A TONG1
1The University Of Sydney, Sydney , Australia, 2Flinders University , Bedford Park, Australia
Aim: To describe clinicians perspectives on disparities of access to dialysis and kidney transplantation in rural communities.
Background: Patients with chronic kidney disease (CKD) requiring kidney replacement therapy in rural communities are at higher risk of mortality compared with patients in urban areas, and encounter many barriers in accessing care.
Methods: We conducted 28 semi-structured interviews with clinicians (Nephrologist’s, Nurses and Social Workers) from Australia. Transcripts were thematically analyzed.
Results: We identified five major themes: the tyranny of distance (overwhelming burden of travel, minimizing relocation distress, scarcity of transportation options, concerns for patient safety), supporting navigating of health systems (reliance on local champions, negotiating variability of literacy, providing flexible pathways, frustrating presence of gatekeepers), disrupted care and lacking services (without continuity of care, scarcity of specialist services, fluctuating capacity for dialysis), pervasive financial distress (crippling out of pocket expenditure, widespread socioeconomic disadvantage), and awareness of rurality (lacking availability of safe and sustainable resources for dialysis, sensitivity to local needs, dependence on social support).
Conclusions: Clinicians felt hampered and frustrated for patients living in rural communities who had reduced access to quality care often due to geography, financial burden, and complexity and rigidity of the health system. Increased use of tele-health, specialist outreach clinics in rural locations and improving flexibility of pathways were suggested to improve access. Further research required in the area of financial hardship for rural patients and their families in accessing kidney replacement therapy.
Nicki is a patient partner, physiotherapist, and a PhD candidate at the Sydney School of Public Health, The University of Sydney. Her research focus is on access to dialysis and transplantation services for rural patients in Australia and she was awarded an NHMRC postgraduate Scholarship commencing 2020. Nicki is a Steering Group member of the Standardised Outcomes in Nephrology (SONG-GN) and AKTN as well as a co-chair of the BEAT-CKD consumer advisory board. Nicki is a member of the ANZSN and is a consumer representative on the Transplant working group and Green Nephrology Action Team (GNAT).