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- Title
Impact of remote location on quality care delivery and relationships to adverse health outcomes in patients with diabetes and chronic kidney disease†.
- Authors
Bello, Aminu K.; Hemmelgarn, Brenda; Lin, Meng; Manns, Braden; Klarenbach, Scott; Thompson, Stephanie; James, Matthew; Tonelli, Marcello
- Abstract
Background To investigate the relation of residence location, markers of good quality healthcare and adverse clinical outcomes in patients with diabetes and chronic kidney disease (CKD). Methods We identified 31 337 individuals with diabetes and estimated glomerular filtration rate (eGFR) 15–59 mL/min/1.73 m2 from a population-based cohort (n= 1 278 375) of adults with serum creatinine measured at least once during 2005 or 2006 in Alberta, Canada. The study population was classified into categories based on travel distance by road from residence location to the closest nephrologist: (0–50, 50.1–100, 100.1–200 and >200 km). Results At follow-up, compared with those living within 50 km, remote dwellers were less likely to visit a nephrologist, less likely to have hemoglobin A1c and urinary albumin measured within 1 year of the index eGFR, and less likely to receive an angiotensin converting enzyme inhibitor, angiotensin receptor blocker or statin (all P < 0.0001). In adjusted models, compared with those with CKD (Stage 3 or 4) living within 50 km, the adjusted likelihood of all-cause hospitalization was [1.4 (95% confidence interval, CI, 1.3–1.6)], [1.3 (95% CI, 1.1–1.6)] and [1.3 (95% CI, 1.2–1.5)]-fold higher for patients living 50.1–100, 100.1–200 and >200 km away from a nephrologist, respectively (P < 0.0001). The hazard ratio of all-cause mortality increased with increasing distance: [1.07 (95% CI, 0.9–1.2)], [1.1 (95% CI, 0.9–1.2)] and [1.2 (95% CI, 1.0–1.4)], respectively (P < 0.0001). Conclusions Compared with those living closer to a nephrologist, remote dwellers with diabetes and CKD were less likely to receive recommended quality care, and more likely to experience adverse health outcomes.
- Subjects
MEDICAL quality control; ADVERSE health care events; HEALTH outcome assessment; PEOPLE with diabetes; CHRONIC kidney failure; CLINICAL trials; GLOMERULAR filtration rate
- Publication
Nephrology Dialysis Transplantation, 2012, Vol 27, Issue 10, p3849
- ISSN
0931-0509
- Publication type
Article