Communication, telehealth are first steps to achieving health equity in transplantation
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As the COVID-19 pandemic continues and health disparities are brought to light around the United States, leaders in the transplant field are getting serious about the journey to health equity.
Just months after the National Kidney Foundation declared health equity its main focus of 2022, CareDx hosted a panel to further discuss disparities in transplantation and potential solutions.
Early communication with patients
Lisa McElroy, MD, MS, abdominal transplant surgeon, health services researcher and assistant professor of surgery in surgery and population health sciences at Duke University School of Medicine in North Carolina, offered her perspective on achieving health equity through examples of what Duke University has done. Early in the pandemic, McElroy’s colleagues at Duke University reached out to patients with the goal of redesigning the way they deliver care. These conversations focused on education, social deprivation and challenges intensified by the pandemic. This led to a more aggressive implementation of telehealth.
“We were able to then take the information they provided us and look more closely at our care processes — the way we were communicating with our patients about the risk to their health, but also the way we were helping to take care of new patients and established patients,” McElroy said. “So, our ability to provide the telehealth to the patients that needed at the most was brought on by early communication with our patients on the list.”
Jay Graham, MD, MBA, FACS, associate professor, abdominal transplant surgeon and pancreas transplantation surgical director at Montefiore Einstein Center for Transplantation in Bronx, New York, noted that in addition to telehealth, remote patient monitoring (RPM) can be beneficial as it allows physicians to intervene earlier with patients.
Graham said, “These digital solutions can offer transparency to the transplant center so that we can intervene a lot earlier to rectify some of the problems before they become a real issue.”
Communication within the health care team as well as with patients can help close the gap of health disparities. Graham noted that at Montefiore Einstein Center for Transplantation, social workers and dialysis centers can be most helpful when deciding how to treat a patient.
“On the pre-transplant side, social workers really know the obstacles that patients are going through, whereas the clinicians may not be able to see that or may have blinders on,” Graham said. He added, “When you have a disadvantaged community, it's all hands on deck and you need to partner with people in the community and then also the private sector and government to obtain excellent outcomes.”
What can be done?
In addition to advances in communication and telehealth, Glenda V. Roberts, director of patient engagement and external relations at the Kidney Research Institute, Center for Dialysis Innovation, in the department of medicine at the University of Washington, spoke about how the removal of the race coefficient in the eGFR equation has brought kidney care one step closer to health equity.
“I would like to see that same concept being applied when organs are being evaluated. We know that the discard rate of kidneys from African Americans is disproportionately high, because the kidney donor profile (KDPI) score says that because a person has a black kidney, it's more likely not to survive as long,” Roberts said. “So, I always ask people, as a Black person, if I got a white kidney, do I now have a Black transplant? I think that makes the point that race is a social construct. It’s not a biological one.”
Additionally, as a transplant recipient herself, Roberts shared that the most helpful thing a clinician can do for a patient is taking the time to educate and communicate with them.
“Even though technological literacy varies widely among our patients, I still think technology has a role to help us communicate with them better, and that extends to the whole transplant journey right from referral all the way through to post-transplant monitoring,” McElroy said. “The challenge is ours: to try to understand how we can best communicate with patients at different phases through the transplant journey.”
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Health Equity Summit; Aug. 18, 2022; virtual meeting.
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