Specific patient factors linked to ED visits after skipped hemodialysis sessions
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Published research found patients with higher severity pain, depression or physical limitations were more likely to skip hemodialysis sessions, leading to subsequent ED use. However, commonly cited social determinants of health — including health literacy and economic stability — did not appear to have an impact.
“Despite growing ED utilization by dialysis patients and its attendant cost and morbidity, prospective studies to identify risk factors for ED utilization by dialysis patients who have missed dialysis treatments remain limited,” Kamna S. Balhara, MD, of the Johns Hopkins University School of Medicine, and colleagues wrote. “... The World Health Organization (WHO), Centers for Disease Control (CDC), and the Healthy People 2020 and 2030 initiatives have all placed an increased focus upon social determinants of health (SDOH), ie the conditions in the places where people live, learn, work, and play. SDOH impact patients’ behavioral choices and are associated with clinical outcomes in ESRD patients.”
The researchers argued that while unmet social determinants of health may play a role in skipped hemodialysis sessions and ED use, the area calls for further investigation. To this end, they compared social determinants of health between 25 cases (those who missed at least one session prior to ED visit) and 24 controls (those deemed adherent to treatments by their nephrologist). Social determinants of health included economic stability, neighborhood and built environment, education, health care access and social/community context. Patient comorbidities were also considered.
Researchers found no significant differences between groups regarding comorbidity burden, economic stability, educational attainment, health literacy or family support. However, patients presenting to the ED who did not adhere to treatment had significantly higher levels of pain, depression and limitations in mobility. They were also more likely to take public transportation to dialysis than controls. Researchers also determined length of stay to be longer for patients who missed sessions.
“Non-adherent dialysis patients who present to the ED require prolonged inpatient visits and use multiple resources while in the ED,” they wrote. “Our findings suggest that an inter-professional approach, incorporating psychiatric services, social work, case management and pain management, may be most effective in addressing the complex, interrelated SDOH that contribute to these patterns of health care utilization.” – by Melissa J. Webb
Disclosures: Balhara reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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