Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2020 Jan 6;21(1):4.
doi: 10.1186/s12882-019-1673-7.

Social determinants of health associated with hemodialysis non-adherence and emergency department utilization: a pilot observational study

Kamna S Balhara  1 , Lori Fisher  2   3 , Naya El Hage  2   4 , Rosemarie G Ramos  5 , Bernard G Jaar  2   6   7   8
Affiliations
Observational Study

Social determinants of health associated with hemodialysis non-adherence and emergency department utilization: a pilot observational study

Kamna S Balhara et al. BMC Nephrol. .

Abstract

Background: Dialysis patients who miss treatments are twice as likely to visit emergency departments (EDs) compared to adherent patients; however, prospective studies assessing ED use after missed treatments are limited. This interdisciplinary pilot study aimed to identify social determinants of health (SDOH) associated with missing hemodialysis (HD) and presenting to the ED, and describe resource utilization associated with such visits.

Methods: We conducted a prospective observational study with a convenience sample of patients presenting to the ED after missing HD (cases); patients at local dialysis centers identified as HD-compliant by their nephrologists served as matched controls. Patients were interviewed with validated instruments capturing associated risk factors, including SDOH. ED resource utilization by cases was determined by chart review. Chi-square tests and ANOVA were used to detect statistically significant group differences.

Results: All cases visiting the ED had laboratory and radiographic studies; 40% needed physician-performed procedures. Mean ED length of stay (LOS) for cases was 17 h; 76% of patients were admitted with average LOS of 6 days. Comparing 25 cases and 24 controls, we found no difference in economic stability, educational attainment, health literacy, family support, or satisfaction with nephrology care. However, cases were more dependent on public transport for dialysis (p = 0.03). Despite comparable comorbidity burdens, cases were more likely to have impaired mobility, physical limitations, and higher severity of pain and depression. (p < 0.05).

Conclusions: ED visits after missed HD resulted in elevated LOS and admission rates. Frequently-cited SDOH such as health literacy did not confer significant risk for missing HD. However, pain, physical limitations, and depression were higher among cases. Community-specific collaborations between EDs and dialysis centers would be valuable in identifying risk factors specific to missed HD and ED use, to develop strategies to improve treatment adherence and reduce unnecessary ED utilization.

Keywords: Dialysis; Emergency department; Non-adherence; Social determinants of health.

PubMed Disclaimer

Conflict of interest statement

Dr. Bernard Jaar is a member of the Editorial Board of BMC Nephrology. The authors declare that they have no additional competing interests.

References

    1. Marcozzi D, Carr B, Liferidge A, Baehr N, Browne B. Trends in the contribution of emergency departments to the provision of hospital-associated health care in the USA. Int J Health Serv. 2018;48:267–288. doi: 10.1177/0020731417734498. - DOI - PubMed
    1. Rui P, Kang K. National Hospital Ambulatory Medical Care Survey: 2015 Emergency Department Summary Tables. http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2015_ed_web_tables.pdf. Accessed 10 Jan 2019.
    1. LaCalle E, Rabin E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med. 2010;56:42–48. doi: 10.1016/j.annemergmed.2010.01.032. - DOI - PubMed
    1. Doupe MB, Palatnick W, Day S, Chateau D, Soodeen RA, Burchill C, et al. Frequent users of emergency departments: developing standard definitions and defining prominent risk factors. Ann Emerg Med. 2012;60:24–32. doi: 10.1016/j.annemergmed.2011.11.036. - DOI - PubMed
    1. Pines J, Asplin BR, Kaji AH, Lowe RA, Magid DJ, Raven M, et al. Frequent users of emergency department services: gaps in knowledge and a proposed research agenda. Acad Emerg Med. 2011;18:e64–e69. doi: 10.1111/j.1553-2712.2011.01086.x. - DOI - PubMed

Publication types