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Kidney Week

Abstract: FR-PO752

Hemodialysis Transportation Modality and Their Effects on Treatment Adherence

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Grant, Candace D., NYU Winthrop Hospital, Mineola, New York, United States
  • Drakakis, James, NYU Winthrop Hospital, Mineola, New York, United States
  • Masani, Naveed N., NYU Winthrop Hospital, Mineola, New York, United States
  • Miyawaki, Nobuyuki (Bill), NYU Winthrop Hospital, Mineola, New York, United States
Background

A common reason for nonadherence to hemodialysis (HD) treatments is difficulty with transportation. Health disparities occur in groups of people that experience suboptimal health care based on their social, economic, and/or environmental disadvantage. The modality used for transportation is dependent on a patient’s socioeconomic status and can be related to health disparities. Identifying how transportation modality affects adherence to HD regiments can hopefully lead to improved strategies in HD transportation and improve clinical outcomes for all HD patients. We examined transportation modality and HD treatment adherence.

Methods

We reviewed the electronic charts of patients enrolled at our outpatient HD units. We identified 306 eligible patients that had documented transportation modality as well as health insurance information. HD compliance was calculated for the group between April 2014 to April 2018.The modes of transportation were designated as self/family (SF), ambulance/ambulette (AMB) and Taxi/AbleRide (TX). Health insurance was divided into three groups: Medicare (MCR), Medicaid (MCD) and private insurance/self-pay (PVT).

Results

The study population was 53% white, 57% male with a median age of 66 years. 59%, 18% and 23% of the patients had MCR, MCD, or PVT for insurance respectively. Patients with more than one mode of transportation (n=20) had an average compliance of 91.27% versus 90.95% with only one mode (n=286). Of the patients with only one mode of transportation, the average compliance was 91.78%, 90.39%, and 88.21% for travel by SF, AMB, and TX, respectively. HD compliance by primary insurance varied at 92.3%, 91.8% and 86.7%, for PVT, MCR and MCD, respectively (P<0.01). When comparing compliance of different transportation modes within the designated insurance groups, there was a significant difference between the modes of transportation at 90.3% and 85% for SF and combined AMB/TX respectively, (p<0.05).

Conclusion

Our findings suggest that health insurance and transportation modality both play a significant role in HD treatment compliance. Patients on MCD experience more health disparities that can interfere with HD regiment complaince. Further prospective studies are required to explore this relationship and why MCD insured patients would experience lower HD compliance when relying on commercial sources for transportation.