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Barriers facing patients referred for kidney transplant cause loss to follow-up.

Kazley AS, Simpson KN, Chavin KD, Baliga P - Kidney Int. (2012)

Bottom Line: End-stage renal disease affects many Americans; however, transplant is the best treatment option increasing life years and offering a higher quality of life than possible with dialysis.These impediments may result from unclear provider communication, misinformation received from peers or other sources, misperceptions related to transplant surgery, or limited health literacy/health decision-making capacity.Thus, patients with end-stage renal disease lost to follow-up after referral for kidney transplant faced both real and perceived barriers pursuing transplantation.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, South Carolina 29464, USA. swansoaj@musc.edu

ABSTRACT
End-stage renal disease affects many Americans; however, transplant is the best treatment option increasing life years and offering a higher quality of life than possible with dialysis. Ironically, many who are eligible for transplant do not follow through on the complex workup protocols required to be placed on the transplant waiting list. Here we surveyed vascular access clinic patients at an academic medical center referred for transplant, who did not follow up on the needed workup to be added to the national transplant waiting list. The most frequent responses of 83 patients for not pursuing transplantation were that the patients did not think they would pass the medical tests, they were scared of getting a transplant, and they could not afford the medicine or the transplantation. These impediments may result from unclear provider communication, misinformation received from peers or other sources, misperceptions related to transplant surgery, or limited health literacy/health decision-making capacity. Thus, patients with end-stage renal disease lost to follow-up after referral for kidney transplant faced both real and perceived barriers pursuing transplantation.

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Related in: MedlinePlus

Steps required for kidney transplant listing (data from 2010)
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Figure 1: Steps required for kidney transplant listing (data from 2010)

Mentions: A single kidney transplant center serves all patients in South Carolina (SC). Patients in SC who are referred for transplant are required to attend a transplant education class as part of the pre-transplant evaluation process. These classes are held in different geographic locations (upstate, midlands, low-country) and at different time points throughout the month. In addition to attending the educational session, the patient is required to complete various medical and psychosocial evaluations and tests based on CMS regulations and transplant center protocol prior to being placed on the transplant waiting list. The criteria for being listed for a kidney transplant in SC are provided in Figure 1, along with the number of patients who completed each step in 2010. This figure illustrates the number of patients that are lost at each step, and only 29.5% of those referred are eventually listed for transplant. The process is monitored for each patient, and any lack of patient follow through is communicated to the patient, the dialysis units and to the referring community nephrologist. The methods of communication include visits to the vascular access clinic, mailings from the transplant center, and phone calls to the patients. Despite this well-structured system of communications, a large number of patients do not progress through the process to fulfill the requirements for wait-listing for a kidney transplant. In SC, only 16.89% of the dialysis patients who are younger than 70 years of age are on the waiting list for a transplant relative to the 18.15% in Network 6 and 24.23% nationally, indicating that many eligible South Carolina patients are either not referred to transplant or are lost to follow up for a kidney transplant. We define lost to follow up as a patient that does not pursue full evaluation for kidney transplant by not completing required components such as the educational class or medical tests. The purpose of this paper is to identify barriers to kidney transplant for patients who have been referred by a physician for transplant. This group of patients receives dialysis and follow-up on referrals to the clinic for vascular access issues, yet they do not complete the required steps to be listed on the kidney transplant waiting list.


Barriers facing patients referred for kidney transplant cause loss to follow-up.

Kazley AS, Simpson KN, Chavin KD, Baliga P - Kidney Int. (2012)

Steps required for kidney transplant listing (data from 2010)
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472088&req=5

Figure 1: Steps required for kidney transplant listing (data from 2010)
Mentions: A single kidney transplant center serves all patients in South Carolina (SC). Patients in SC who are referred for transplant are required to attend a transplant education class as part of the pre-transplant evaluation process. These classes are held in different geographic locations (upstate, midlands, low-country) and at different time points throughout the month. In addition to attending the educational session, the patient is required to complete various medical and psychosocial evaluations and tests based on CMS regulations and transplant center protocol prior to being placed on the transplant waiting list. The criteria for being listed for a kidney transplant in SC are provided in Figure 1, along with the number of patients who completed each step in 2010. This figure illustrates the number of patients that are lost at each step, and only 29.5% of those referred are eventually listed for transplant. The process is monitored for each patient, and any lack of patient follow through is communicated to the patient, the dialysis units and to the referring community nephrologist. The methods of communication include visits to the vascular access clinic, mailings from the transplant center, and phone calls to the patients. Despite this well-structured system of communications, a large number of patients do not progress through the process to fulfill the requirements for wait-listing for a kidney transplant. In SC, only 16.89% of the dialysis patients who are younger than 70 years of age are on the waiting list for a transplant relative to the 18.15% in Network 6 and 24.23% nationally, indicating that many eligible South Carolina patients are either not referred to transplant or are lost to follow up for a kidney transplant. We define lost to follow up as a patient that does not pursue full evaluation for kidney transplant by not completing required components such as the educational class or medical tests. The purpose of this paper is to identify barriers to kidney transplant for patients who have been referred by a physician for transplant. This group of patients receives dialysis and follow-up on referrals to the clinic for vascular access issues, yet they do not complete the required steps to be listed on the kidney transplant waiting list.

Bottom Line: End-stage renal disease affects many Americans; however, transplant is the best treatment option increasing life years and offering a higher quality of life than possible with dialysis.These impediments may result from unclear provider communication, misinformation received from peers or other sources, misperceptions related to transplant surgery, or limited health literacy/health decision-making capacity.Thus, patients with end-stage renal disease lost to follow-up after referral for kidney transplant faced both real and perceived barriers pursuing transplantation.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, South Carolina 29464, USA. swansoaj@musc.edu

ABSTRACT
End-stage renal disease affects many Americans; however, transplant is the best treatment option increasing life years and offering a higher quality of life than possible with dialysis. Ironically, many who are eligible for transplant do not follow through on the complex workup protocols required to be placed on the transplant waiting list. Here we surveyed vascular access clinic patients at an academic medical center referred for transplant, who did not follow up on the needed workup to be added to the national transplant waiting list. The most frequent responses of 83 patients for not pursuing transplantation were that the patients did not think they would pass the medical tests, they were scared of getting a transplant, and they could not afford the medicine or the transplantation. These impediments may result from unclear provider communication, misinformation received from peers or other sources, misperceptions related to transplant surgery, or limited health literacy/health decision-making capacity. Thus, patients with end-stage renal disease lost to follow-up after referral for kidney transplant faced both real and perceived barriers pursuing transplantation.

Show MeSH
Related in: MedlinePlus