High number of dialysis cases impacts social determinants of health

September 16, 2021

3 minutes to read

Disclosures: Witten and Browne do not report any relevant financial information.


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A growing body of literature on the social determinants of health suggests the critical importance of these social and psychological barriers to the outcomes of people with kidney disease.

With COVID-19 impacting vulnerable populations, it is time to address potential mismatches between patient and staff needs and clinic resources.

The problem

The COVID-19 pandemic has increased the risk of depression,1 anxiety2 and financial hardship3 for dialysis patients. A study published in 20204 evaluated the effect of the pandemic on the psychosocial health of hemodialysis patients in the center and found the following:

Beth witten
  • almost 80% reported moderate to extreme concern about the effects of the pandemic on their mental / emotional health and interpersonal relationships;
  • over 85% were concerned about having dialysis due to the risk of close contact in the clinic or during transport;
  • 27% had clinical levels of depressive symptoms;
  • 33% reported poor quality of sleep;
  • perceived stress was high in about 30% of cases, 85% of whom felt overwhelmed by the pandemic;
  • 90% were concerned about housing insecurity; and
  • 30% reported food insecurity.

A 2020 survey by the American Nephrology Nurses Association 5 of nurses’ responses to the pandemic found the following:

  • 67% often had difficulty relaxing;
  • 47% had difficulty controlling their worries or fears; and
  • 62% felt exhausted.

In the survey, 47% of nurses said work “hardens their emotions,” which is a sign of compassion fatigue.

Opportunities for change

The ESRD Treatment Choices model, launched in January, offers clinics new opportunities to increase dialysis and home transplant rates. It is important to overcome critical psychosocial barriers to home dialysis and transplantation. A benefit for patients who choose the best option is a better “fit” to treatment and a better health-related quality of life.

Vocational rehabilitation has always been a goal of the end-stage renal disease program. According to the US Renal Data System’s 2020 Annual Data Report, 23% of patients aged 18 to 54 worked full or part time from 2016 to 2018.6

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Helping patients who are willing and able to work to keep their jobs or find a new one pays great dividends: patients experience reduced stress and greater financial stability, and clinics benefit from higher reimbursement from health plans collectives of employees in relation to the payment of health insurance.

A 2005 study found that the high number of cases in Connecticut dialysis clinics limited the ability of social workers to provide clinical interventions to their patients.7 A national survey conducted between 2014 and 2017 found that the number of cases Social work increased for part-time and full-time social workers by about 130 per social worker working 40 hours per week, with part-time social workers having even higher relative workloads.

With higher workloads in 2017, “68% of social workers did not have enough time to deal with cases or advice, 62% did not have enough time to educate patients and 36% did said they spend too much time doing office work, insurance and billing. tasks ”, according to the results of the survey.8

We know that depression and poor physical and mental function predict an increased risk of missed treatments, hospitalization and death. Likewise, better staffing could reduce patient complaints and improve patient satisfaction scores – a win-win situation for patients, staff and clinics.

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