Abstract: TH-PO306
Association of Primary Care Continuity with Home Dialysis, Transplantation, and Utilization of Medical Services for Patients Starting Hemodialysis
Session Information
- Hemodialysis and Frequent Dialysis - 1
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Wyman, Cole, Queen's University, Kingston, Ontario, Canada
- Djerboua, Maya, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Clemens, Kristin, Division of Endocrinology and Metabolism and Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Sood, Manish M., University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Silver, Samuel A., Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
Background
Primary care involvement may help patients starting dialysis with care coordination and support. It is unknown whether higher primary care physician (PCP) continuity associates with increased utilization of medical services or helps support patients towards home dialysis and kidney transplantation.
Methods
Using administrative databases in Ontario, Canada, we conducted a population-based study of patients initiating maintenance hemodialysis between 2007 and 2017. We defined PCP continuity as a high usual provider of care index, >75% of PCP visits with the same PCP in the 2 years before dialysis (an established measure of PCP continuity). We used propensity scores to match patients with high and low continuity so that indicators of baseline health were similar. The primary outcomes were time to home dialysis (peritoneal or hemodialysis) and kidney transplantation, adjusted for the competing risk of death. Secondary outcomes included specialist visits, cancer screening, influenza vaccination, and measures of diabetes care.
Results
We identified 9530 matched pairs. High PCP continuity was not associated with increased home dialysis transfer (14.0 events per 100 person-years versus 14.0 events per 100 person-years; hazard ratio 1.00; 95% CI 0.97-1.04) or kidney transplantation (4.3 events per 100 person-years versus 4.5 events per 100 person-years; hazard ratio 0.97; 95% CI 0.90-1.04). There were no differences in utilization of medical services, with the exception of high PCP continuity associated with greater colon cancer screening (hazard ratio 1.07, 95% CI 1.01-1.14), influenza vaccination (hazard ratio 1.33, 95% CI 1.27-1.39), and comprehensive diabetes care (hazard ratio 1.23, 95% CI 1.14-1.33).
Conclusion
High PCP continuity during the transition to dialysis was not associated with increased utilization of home dialysis or transplantation and had only small effects on preventative services outside of influenza vaccination and comprehensive diabetes care. Given the competing health and time demands of patients on maintenance hemodialysis, additional work is needed to clarify how primary care may benefit this patient population.
Funding
- Government Support – Non-U.S.