Aminu K. Bello|Brenda R. Hemmelgarn|Min Lin|Braden Manns|Scott Klarenbach|Stephanie Thompson|Matthew T. James|Marcello Tonelli
Impact of remote location on quality care delivery and relationships to adverse health outcomes in patients with diabetes and chronic kidney disease
University of Alberta|University of Calgary|University of Alberta|University of Calgary|University of Alberta|University of Alberta|University of Calgary|University of Alberta
investigate relation residence location markers good quality healthcare adverse clinical outcomes patients diabetes chronic kidney disease ckd identified 31 337 individuals diabetes estimated glomerular filtration rate egfr 1559 mlmin173 m2 populationbased cohort n 1 278 375 adults serum creatinine measured least 2005 2006 alberta canada study population classified categories based travel distance road residence location closest nephrologist 050 501100 1001200 200 km followup compared living within 50 km remote dwellers less likely visit nephrologist less likely hemoglobin a1c urinary albumin measured within 1 year index egfr less likely receive angiotensin converting enzyme inhibitor angiotensin receptor blocker statin p 00001 adjusted models compared ckd stage 3 4 living within 50 km adjusted likelihood allcause hospitalization 14 95 confidence interval ci 1316 13 95 ci 1116 13 95 ci 1215fold higher patients living 501100 1001200 200 km away nephrologist respectively p 00001 hazard ratio allcause mortality increased increasing distance 107 95 ci 0912 11 95 ci 0912 12 95 ci 1014 respectively p 00001 compared living closer nephrologist remote dwellers diabetes ckd less likely receive recommended quality care likely experience adverse health outcomes