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Abstract: SA-PO1053

Association Among Primary Care Involvement, Death, and Hospitalizations for Patients Newly Started on Dialysis: A Population-Based Study from Ontario, Canada

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Silver, Samuel A., Queen's University, Kingston, Ontario, Canada
  • McArthur, Eric, Institute for Clinical Evaluative Sciences, London, Ontario, Canada
  • Clemens, Kristin, Western University, London, Ontario, Canada
  • Wald, Ron, St. Michael's Hospital, Toronto, Ontario, Canada
  • Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
Background

The transition to dialysis is a vulnerable time, where patients may benefit from nephrology and primary care support. However, the role of primary care for patients on dialysis is poorly defined. We sought to determine whether primary care physician (PCP) involvement during the transition to dialysis improves outcomes.

Methods

Using linked administrative databases in Ontario, Canada, we conducted a population-based study of patients who initiated chronic dialysis between 2005-2014 and survived at least 90 days. We defined persistent PCP involvement as both 1) high usual provider of care index in the 2 years before dialysis, an established measure of PCP continuity and 2) ≥1 visit with the usual provider in the 90-days after dialysis initiation. We used propensity scores to match patients 1:1 based on indicators of baseline health. The primary outcome was all-cause mortality and secondary outcomes included all-cause and disease-specific hospitalizations.

Results

We identified 19,099 patients who survived for >90 days. There were 6612 patients (35%) with persistent PCP involvement who were matched 1:1 to 6391 patients without persistent PCP involvement. Persistent PCP involvement was not associated with a lower risk of mortality 2 years after cohort entry (14.5 deaths per 100 person-years vs 15.2 deaths per 100 person-years; hazard ratio [HR] 0.96, 95% CI 0.89-1.02). There was no difference in the rate of all-cause hospitalizations (HR 0.96, 95% CI 0.92-1.01), and persistent PCP involvement was not associated with a lower risk of any disease-specific hospitalization except for diabetes (HR 0.88, 95% CI 0.80-0.97).

Conclusion

Persistent PCP involvement during the transition to dialysis was not associated with a lower risk of mortality or all-cause hospitalization. These additional visits have opportunity costs for patients and economic costs for the healthcare system, suggesting primary care redesign may be needed to better support patients during this vulnerable period.