Patient view of dialysis care did not change during COVID-19; other health aspects did
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Key takeaways:
- Most study participants felt “very” or “usually” connected to their dialysis team during the pandemic.
- Transportation issues were a problem for 17% of participants and 6% had trouble obtaining medications.
Perceptions of dialysis care did not change for most patients during the COVID-19 crisis, but recently published data show other aspects of their lives may have been affected.
“Changes to an otherwise routine schedule may worsen anxiety for many patients,” Elyssa M. Noce, MSN, APRN, AGPCNP-C, CDN, of the department of internal medicine in nephrology at Yale-New Haven Hospital in Connecticut, and colleagues, wrote. “We sought to define ways in which the experiences of care of patients receiving dialysis were affected by the COVID-19 pandemic and its associated changes to health services.”
Transportation issues
on-white, those with histories of mental health conditions and individuals being treated by in-center hemodialysis faced difficulties in maintaining care. Finding transportation, for example, became challenging for certain subgroups, which researchers suggest may have led to poor outcomes for mental and physical health.
The study team verbally administered surveys after the first wave of the pandemic, including Likert scale multiple-choice questions and open-ended questions, to 172 adults receiving dialysis. Primary outcomes were changes in health and care experience.
Survey questions covered how connected patients felt to their dialysis team, how easily they were able to reach someone on staff, how they perceived changes in dialysis care and how access to daily living essentials changed during the pandemic.
Most participants felt “very” or “usually” connected to their dialysis team, according to the study, with patients on home dialysis recording better marks than in-center patients. Black and Hispanic participants, however, less commonly felt “very connected” to care.
In terms of reaching their dialysis team, participants mostly felt they could “always” or “usually” reach someone, the survey showed. Participants receiving home dialysis and those who identified as white commonly reported they could “always reach someone.”
Overall, 27% of participants said they felt more cared for during the pandemic, while 68% felt their care had not changed. Nine participants (5%) felt less cared for, according to the study. Most of this group previously self-identified histories of anxiety and/or depression.
Essential activities including travel became hurdles: 17% of participants reported transportation issues during the pandemic, 6% had trouble obtaining medications, 9% had difficulties getting groceries and 20% found it hard to maintain their diet. These issues compounded for non-white and those on in-center dialysis.
Impact of the pandemic
Four major themes emerged from the results, according to researchers. First, the pandemic did not significantly affect participants' experience of dialysis care. Second, it did impact other aspects of their lives, such as obtaining medications and getting groceries, which in turn affected mental and physical health. Third, participants valued consistency, dependability and personal connection to staff in their dialysis care. Lastly, the pandemic highlighted the importance of external social support, such as family and friends.
The study had some limitations, including that the surveys were administered early in the pandemic and patient perspectives have not been reassessed. Further research may provide a more comprehensive understanding of the experiences of patients.
“The COVID-19 pandemic has impacted the lives of patients receiving dialysis, but this vulnerable patient population has remained resilient,” the researchers wrote. “Support from dialysis care teams, family and caregivers has been a positive influence. Patients who are non-white, receiving [in-center hemodialysis] ICHD or have preexisting histories of anxiety or depression may benefit from closer assessment during this time.”
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