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Financial barriers to health care access may increase distress in patients with CKD
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Financial barriers to obtaining and accessing health care services were significantly associated with depression and anxiety in patients with chronic kidney disease, according to a published study.
“Lack of health insurance, health care continuity and/or high out-of-pocket medical expenses are barriers to accessing health care and adhering to life-sustaining treatment regimens of many people with CKD,” Namkee G. Choi, PhD, of the University of Texas at Austin Steve Hicks School of Social Work, and colleagues wrote. “Individuals with a CKD diagnosis also disproportionately suffer from psychological distress, notably depression and anxiety, compared to those with other chronic illnesses. Psychological distress negatively affects treatment adherence and outcomes including time to dialysis initiation, hospitalizations, quality of life and death. Despite the plethora of research on limited access to care among CKD patients due to low income and lack of health insurance, little research has been done on the relationship between healthcare access and psychological distress.”
Researchers conducted an observational study of 3,923 patients who had been diagnosed with CKD in the preceding 12 months. Psychological distress was measured with the six-item Kessler, which included how often the patient felt nervous, restless, “so depressed that nothing cheered them up,” hopeless, worthless and that “everything was an effort” in the past 30 days. These scores were used to categorize patients into one of three categories: no distress; mild-moderate distress; and serious distress.
Barriers to health care access included lack of health insurance coverage, lack of a usual source of health care and financial barriers to accessing/obtaining health care (eg, medical specialist services, prescription drugs, mental health counseling and dental care).
Of the total study population, 15% reported mild-moderate and 11% reported serious psychological distress.
Patients with mild-moderate and serious distress were younger than those with no distress. They were also less likely to have worked in the preceding year and had more chronic medical conditions, as well as more visits to an emergency department.
“Notably, significant proportions of emergency department users reported that they used the emergency department because it was their usual source of care or they had no other source of care,” the researchers wrote.
Each financial barrier to health care access was associated with mild-moderate and serious distress.
The researchers concluded that the observed association necessitated improvements in several areas. These include reducing high rates of emergency department visits and hospitalizations by increasing access to preventive/routine care — especially among low-income patients — and assessing mental health in early CKD stages rather than only once the patient reaches dialysis.
“While pharmacotherapy is the most prevalent treatment for depression and anxiety, given the high medication count among CKD patients, psychosocial interventions should be considered,” the researchers wrote.
Lastly, “people with CKD and psychological distress should also be offered case management and social services to aid them in navigating the health care system and coping with personal stressors.”– by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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