Kamna S. Balhara|Lori A. Fisher|Naya El Hage|Rosemarie G. Ramos|Bernard G. Jaar
Social determinants of health associated with hemodialysis non-adherence and emergency department utilization: a pilot observational study
Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University|The University of Texas Health Science Center at San Antonio|Johns Hopkins Medicine|Johns Hopkins University
abstract background dialysis patients miss treatments twice likely visit emergency departments eds compared adherent patients however prospective studies assessing ed use missed treatments limited interdisciplinary pilot study aimed identify social determinants health sdoh associated missing hemodialysis hd presenting ed describe resource utilization associated visits methods conducted prospective observational study convenience sample patients presenting ed missing hd cases patients local dialysis centers identified hdcompliant nephrologists served matched controls patients interviewed validated instruments capturing associated risk factors including sdoh ed resource utilization cases determined chart review chisquare tests anova used detect statistically significant group differences results cases visiting ed laboratory radiographic studies 40 needed physicianperformed procedures mean ed length stay los cases 17 h 76 patients admitted average los 6 days comparing 25 cases 24 controls found difference economic stability educational attainment health literacy family support satisfaction nephrology care however cases dependent public transport dialysis p 003 despite comparable comorbidity burdens cases likely impaired mobility physical limitations higher severity pain depression p lt 005 conclusions ed visits missed hd resulted elevated los admission rates frequentlycited sdoh health literacy confer significant risk missing hd however pain physical limitations depression higher among cases communityspecific collaborations eds dialysis centers would valuable identifying risk factors specific missed hd ed use develop strategies improve treatment adherence reduce unnecessary ed utilization