Saturday, March 16, 2013

Race, Geography May Determine if Patient is Given Healthcare, Could be Life-Threatening

My opinion: This information is so important not only for those with kidney diseases, but also for people with others illnesses.  If this holds true for many illnesses, than it affects a much wider range of people and is therefore worth investigating.  Though it is clear that healthcare might be worse in some areas rather than others, here, it appears that racial minorities and people in certain geographic areas are not receiving any healthcare at all, even though it is recommended.  Unfortunately, the article doesn't give too many reasons for why this occurs.  Though funding and Medicare certainly may be a part of the issue, I think there are other factors involved.  For example, how come people medium sized areas get the care they need?  Maybe the healthcare is good enough in these areas and there every patient has access to healthcare.  In rural areas, healthcare is difficult to find, and in larger areas, there may not be enough doctors and nurses, among other medical specialists, to serve patients.  The article does mention that telemedicine and pinpointed at risk areas could help the situation, but until we know all the factors, it might be impossible to formulate the best solution.  Feel free to give your own insight and explanations. 

From: http://medicalxpress.com/news/2013-03-geographic-affect-patients-kidney-disease.html

Timely receipt of care from a kidney specialist over the course of CKD is crucial for slowing the disease, improving survival while on long-term dialysis, and increasing the likelihood of receiving a kidney transplant. And while clinical guidelines recommend that all patients in later stages of CKD be under the care of kidney specialists, 25% to 50% of patients on dialysis in the United States had not received such care before they developed kidney failure, or end-stage renal disease (ESRD). Also, black patients with CKD are less likely to receive optimal kidney care and are more likely to develop ESRD than white patients. Guofen Yan, PhD (University of Virginia School of Medicine) and her colleagues wondered whether geography plays any role in access to pre–ESRD care among black and white CKD patients. They analyzed information from 404,622 white and black adult patients receiving dialysis between 2005 and 2010 and residing in 3,076 counties across the United States. The counties were grouped into large metropolitan, medium/small metropolitan, suburban, and rural counties. Among the major findings: Fewer patients received kidney specialist care for more than 12 months before developing ESRD in large-metro (25.7%) and rural (26.9%) counties than in medium/small-metro counties (31.6%). In all four geographic areas, black patients received less pre-ESRD care than their white counterparts. In large-metro counties, black patients were 27% less likely than whites to receive kidney specialist care for more than 12 months before developing ESRD. In rural counties, they were 16% less likely. In suburban and rural counties, black patients were 30% to 52% less likely than whites to see a dietitian before developing ESRD. "These significant geographic differences in receiving pre-ESRD care and the substantially large racial differences in certain geographic areas highlight the complexity of the issue, and may explain in part the limited progress in improving racial disparities in kidney disease care and outcomes," said Dr. Yan. "Our findings suggest improving receipt of key pre-ESRD care will require more refined regional characterization of health care needs," she added.

Read more at: http://medicalxpress.com/news/2013-03-geographic-affect-patients-kidney-disease.html#jCp
Timely receipt of care from a kidney specialist over the course of CKD is crucial for slowing the disease, improving survival while on long-term dialysis, and increasing the likelihood of receiving a kidney transplant. And while clinical guidelines recommend that all patients in later stages of CKD be under the care of kidney specialists, 25% to 50% of patients on dialysis in the United States had not received such care before they developed kidney failure, or end-stage renal disease (ESRD). Also, black patients with CKD are less likely to receive optimal kidney care and are more likely to develop ESRD than white patients. Guofen Yan, PhD (University of Virginia School of Medicine) and her colleagues wondered whether geography plays any role in access to pre–ESRD care among black and white CKD patients. They analyzed information from 404,622 white and black adult patients receiving dialysis between 2005 and 2010 and residing in 3,076 counties across the United States. The counties were grouped into large metropolitan, medium/small metropolitan, suburban, and rural counties. Among the major findings: Fewer patients received kidney specialist care for more than 12 months before developing ESRD in large-metro (25.7%) and rural (26.9%) counties than in medium/small-metro counties (31.6%). In all four geographic areas, black patients received less pre-ESRD care than their white counterparts. In large-metro counties, black patients were 27% less likely than whites to receive kidney specialist care for more than 12 months before developing ESRD. In rural counties, they were 16% less likely. In suburban and rural counties, black patients were 30% to 52% less likely than whites to see a dietitian before developing ESRD. "These significant geographic differences in receiving pre-ESRD care and the substantially large racial differences in certain geographic areas highlight the complexity of the issue, and may explain in part the limited progress in improving racial disparities in kidney disease care and outcomes," said Dr. Yan. "Our findings suggest improving receipt of key pre-ESRD care will require more refined regional characterization of health care needs," she added.

Read more at: http://medicalxpress.com/news/2013-03-geographic-affect-patients-kidney-disease.html#jCpdtyjdty
Timely receipt of care from a kidney specialist over the course of CKD is crucial for slowing the disease, improving survival while on long-term dialysis, and increasing the likelihood of receiving a kidney transplant. And while clinical guidelines recommend that all patients in later stages of CKD be under the care of kidney specialists, 25% to 50% of patients on dialysis in the United States had not received such care before they developed kidney failure, or end-stage renal disease (ESRD). Also, black patients with CKD are less likely to receive optimal kidney care and are more likely to develop ESRD than white patients. Guofen Yan, PhD (University of Virginia School of Medicine) and her colleagues wondered whether geography plays any role in access to pre–ESRD care among black and white CKD patients. They analyzed information from 404,622 white and black adult patients receiving dialysis between 2005 and 2010 and residing in 3,076 counties across the United States. The counties were grouped into large metropolitan, medium/small metropolitan, suburban, and rural counties. Among the major findings: Fewer patients received kidney specialist care for more than 12 months before developing ESRD in large-metro (25.7%) and rural (26.9%) counties than in medium/small-metro counties (31.6%). In all four geographic areas, black patients received less pre-ESRD care than their white counterparts. In large-metro counties, black patients were 27% less likely than whites to receive kidney specialist care for more than 12 months before developing ESRD. In rural counties, they were 16% less likely. In suburban and rural counties, black patients were 30% to 52% less likely than whites to see a dietitian before developing ESRD. "These significant geographic differences in receiving pre-ESRD care and the substantially large racial differences in certain geographic areas highlight the complexity of the issue, and may explain in part the limited progress in improving racial disparities in kidney disease care and outcomes," said Dr. Yan. "Our findings suggest improving receipt of key pre-ESRD care will require more refined regional characterization of health care needs," she added.

Read more at: http://medicalxpress.com/news/2013-03-geographic-affect-patients-kidney-disease.html#jCpgjkbjk
Timely receipt of care from a kidney specialist over the course of CKD is crucial for slowing the disease, improving survival while on long-term dialysis, and increasing the likelihood of receiving a kidney transplant. And while clinical guidelines recommend that all patients in later stages of CKD be under the care of kidney specialists, 25% to 50% of patients on dialysis in the United States had not received such care before they developed kidney failure, or end-stage renal disease (ESRD). Also, black patients with CKD are less likely to receive optimal kidney care and are more likely to develop ESRD than white patients. Guofen Yan, PhD (University of Virginia School of Medicine) and her colleagues wondered whether geography plays any role in access to pre–ESRD care among black and white CKD patients. They analyzed information from 404,622 white and black adult patients receiving dialysis between 2005 and 2010 and residing in 3,076 counties across the United States. The counties were grouped into large metropolitan, medium/small metropolitan, suburban, and rural counties. Among the major findings: Fewer patients received kidney specialist care for more than 12 months before developing ESRD in large-metro (25.7%) and rural (26.9%) counties than in medium/small-metro counties (31.6%). In all four geographic areas, black patients received less pre-ESRD care than their white counterparts. In large-metro counties, black patients were 27% less likely than whites to receive kidney specialist care for more than 12 months before developing ESRD. In rural counties, they were 16% less likely. In suburban and rural counties, black patients were 30% to 52% less likely than whites to see a dietitian before developing ESRD. "These significant geographic differences in receiving pre-ESRD care and the substantially large racial differences in certain geographic areas highlight the complexity of the issue, and may explain in part the limited progress in improving racial disparities in kidney disease care and outcomes," said Dr. Yan. "Our findings suggest improving receipt of key pre-ESRD care will require more refined regional characterization of health care needs," she added.

Read more at: http://medicalxpress.com/news/2013-03-geographic-affect-patients-kidney-disease.html#jCp
Timely receipt of care from a kidney specialist over the course of CKD is crucial for slowing the disease, improving survival while on long-term dialysis, and increasing the likelihood of receiving a kidney transplant. And while clinical guidelines recommend that all patients in later stages of CKD be under the care of kidney specialists, 25% to 50% of patients on dialysis in the United States had not received such care before they developed kidney failure, or end-stage renal disease (ESRD). Also, black patients with CKD are less likely to receive optimal kidney care and are more likely to develop ESRD than white patients. Guofen Yan, PhD (University of Virginia School of Medicine) and her colleagues wondered whether geography plays any role in access to pre–ESRD care among black and white CKD patients. They analyzed information from 404,622 white and black adult patients receiving dialysis between 2005 and 2010 and residing in 3,076 counties across the United States. The counties were grouped into large metropolitan, medium/small metropolitan, suburban, and rural counties. Among the major findings: Fewer patients received kidney specialist care for more than 12 months before developing ESRD in large-metro (25.7%) and rural (26.9%) counties than in medium/small-metro counties (31.6%). In all four geographic areas, black patients received less pre-ESRD care than their white counterparts. In large-metro counties, black patients were 27% less likely than whites to receive kidney specialist care for more than 12 months before developing ESRD. In rural counties, they were 16% less likely. In suburban and rural counties, black patients were 30% to 52% less likely than whites to see a dietitian before developing ESRD. "These significant geographic differences in receiving pre-ESRD care and the substantially large racial differences in certain geographic areas highlight the complexity of the issue, and may explain in part the limited progress in improving racial disparities in kidney disease care and outcomes," said Dr. Yan. "Our findings suggest improving receipt of key pre-ESRD care will require more refined regional characterization of health care needs," she added. In an accompanying editorial, Kevin Abbott, MD, Robert Nee, MD, and Christina Yuan, MD (Walter Reed National Military Medical Center) stated that Dr. Yan and colleagues' key finding "is that healthcare policies directed at eliminating pre-ESRD care disparities will not necessarily make 'the crooked way straight.' The way forward is likely to be anything but 'straightforward'—but there are potential investigative and intervention tools available." For example, they pointed to the use of geospatial analysis to quantify current and future healthcare needs in high risk regions and to identify mismatches between needs and available resources. Also, telemedicine could potentially improve access to quality care to otherwise isolated communities, either rural or urban, they wrote.

Read more at: http://medicalxpress.com/news/2013-03-geographic-affect-patients-kidney-disease.html#jCp
Timely receipt of care from a kidney specialist over the course of CKD is crucial for slowing the disease, improving survival while on long-term dialysis, and increasing the likelihood of receiving a kidney transplant. And while clinical guidelines recommend that all patients in later stages of CKD be under the care of kidney specialists, 25% to 50% of patients on dialysis in the United States had not received such care before they developed kidney failure, or end-stage renal disease (ESRD). Also, black patients with CKD are less likely to receive optimal kidney care and are more likely to develop ESRD than white patients. Guofen Yan, PhD (University of Virginia School of Medicine) and her colleagues wondered whether geography plays any role in access to pre–ESRD care among black and white CKD patients. They analyzed information from 404,622 white and black adult patients receiving dialysis between 2005 and 2010 and residing in 3,076 counties across the United States. The counties were grouped into large metropolitan, medium/small metropolitan, suburban, and rural counties. Among the major findings: Fewer patients received kidney specialist care for more than 12 months before developing ESRD in large-metro (25.7%) and rural (26.9%) counties than in medium/small-metro counties (31.6%). In all four geographic areas, black patients received less pre-ESRD care than their white counterparts. In large-metro counties, black patients were 27% less likely than whites to receive kidney specialist care for more than 12 months before developing ESRD. In rural counties, they were 16% less likely. In suburban and rural counties, black patients were 30% to 52% less likely than whites to see a dietitian before developing ESRD. "These significant geographic differences in receiving pre-ESRD care and the substantially large racial differences in certain geographic areas highlight the complexity of the issue, and may explain in part the limited progress in improving racial disparities in kidney disease care and outcomes," said Dr. Yan. "Our findings suggest improving receipt of key pre-ESRD care will require more refined regional characterization of health care needs," she added. In an accompanying editorial, Kevin Abbott, MD, Robert Nee, MD, and Christina Yuan, MD (Walter Reed National Military Medical Center) stated that Dr. Yan and colleagues' key finding "is that healthcare policies directed at eliminating pre-ESRD care disparities will not necessarily make 'the crooked way straight.' The way forward is likely to be anything but 'straightforward'—but there are potential investigative and intervention tools available." For example, they pointed to the use of geospatial analysis to quantify current and future healthcare needs in high risk regions and to identify mismatches between needs and available resources. Also, telemedicine could potentially improve access to quality care to otherwise isolated communities, either rural or urban, they wrote.

Read more at: http://medicalxpress.com/news/2013-03-geographic-affect-patients-kidney-disease.html#jCp
Timely receipt of care from a kidney specialist over the course of CKD is crucial for slowing the disease, improving survival while on long-term dialysis, and increasing the likelihood of receiving a kidney transplant. And while clinical guidelines recommend that all patients in later stages of CKD be under the care of kidney specialists, 25% to 50% of patients on dialysis in the United States had not received such care before they developed kidney failure, or end-stage renal disease (ESRD). Also, black patients with CKD are less likely to receive optimal kidney care and are more likely to develop ESRD than white patients. Guofen Yan, PhD (University of Virginia School of Medicine) and her colleagues wondered whether geography plays any role in access to pre–ESRD care among black and white CKD patients. They analyzed information from 404,622 white and black adult patients receiving dialysis between 2005 and 2010 and residing in 3,076 counties across the United States. The counties were grouped into large metropolitan, medium/small metropolitan, suburban, and rural counties. Among the major findings: Fewer patients received kidney specialist care for more than 12 months before developing ESRD in large-metro (25.7%) and rural (26.9%) counties than in medium/small-metro counties (31.6%). In all four geographic areas, black patients received less pre-ESRD care than their white counterparts. In large-metro counties, black patients were 27% less likely than whites to receive kidney specialist care for more than 12 months before developing ESRD. In rural counties, they were 16% less likely. In suburban and rural counties, black patients were 30% to 52% less likely than whites to see a dietitian before developing ESRD. "These significant geographic differences in receiving pre-ESRD care and the substantially large racial differences in certain geographic areas highlight the complexity of the issue, and may explain in part the limited progress in improving racial disparities in kidney disease care and outcomes," said Dr. Yan. "Our findings suggest improving receipt of key pre-ESRD care will require more refined regional characterization of health care needs," she added. In an accompanying editorial, Kevin Abbott, MD, Robert Nee, MD, and Christina Yuan, MD (Walter Reed National Military Medical Center) stated that Dr. Yan and colleagues' key finding "is that healthcare policies directed at eliminating pre-ESRD care disparities will not necessarily make 'the crooked way straight.' The way forward is likely to be anything but 'straightforward'—but there are potential investigative and intervention tools available." For example, they pointed to the use of geospatial analysis to quantify current and future healthcare needs in high risk regions and to identify mismatches between needs and available resources. Also, telemedicine could potentially improve access to quality care to otherwise isolated communities, either rural or urban, they wrote.

Read more at: http://medicalxpress.com/news/2013-03-geographic-affect-patients-kidney-disease.html#jCp
Timely receipt of care from a kidney specialist over the course of CKD is crucial for slowing the disease, improving survival while on long-term dialysis, and increasing the likelihood of receiving a kidney transplant. And while clinical guidelines recommend that all patients in later stages of CKD be under the care of kidney specialists, 25% to 50% of patients on dialysis in the United States had not received such care before they developed kidney failure, or end-stage renal disease (ESRD). Also, black patients with CKD are less likely to receive optimal kidney care and are more likely to develop ESRD than white patients. Guofen Yan, PhD (University of Virginia School of Medicine) and her colleagues wondered whether geography plays any role in access to pre–ESRD care among black and white CKD patients. They analyzed information from 404,622 white and black adult patients receiving dialysis between 2005 and 2010 and residing in 3,076 counties across the United States. The counties were grouped into large metropolitan, medium/small metropolitan, suburban, and rural counties. Among the major findings: Fewer patients received kidney specialist care for more than 12 months before developing ESRD in large-metro (25.7%) and rural (26.9%) counties than in medium/small-metro counties (31.6%). In all four geographic areas, black patients received less pre-ESRD care than their white counterparts. In large-metro counties, black patients were 27% less likely than whites to receive kidney specialist care for more than 12 months before developing ESRD. In rural counties, they were 16% less likely. In suburban and rural counties, black patients were 30% to 52% less likely than whites to see a dietitian before developing ESRD. "These significant geographic differences in receiving pre-ESRD care and the substantially large racial differences in certain geographic areas highlight the complexity of the issue, and may explain in part the limited progress in improving racial disparities in kidney disease care and outcomes," said Dr. Yan. "Our findings suggest improving receipt of key pre-ESRD care will require more refined regional characterization of health care needs," she added. In an accompanying editorial, Kevin Abbott, MD, Robert Nee, MD, and Christina Yuan, MD (Walter Reed National Military Medical Center) stated that Dr. Yan and colleagues' key finding "is that healthcare policies directed at eliminating pre-ESRD care disparities will not necessarily make 'the crooked way straight.' The way forward is likely to be anything but 'straightforward'—but there are potential investigative and intervention tools available." For example, they pointed to the use of geospatial analysis to quantify current and future healthcare needs in high risk regions and to identify mismatches between needs and available resources. Also, telemedicine could potentially improve access to quality care to otherwise isolated communities, either rural or urban, they wrote.

Read more at: http://medicalxpress.com/news/2013-03-geographic-affect-patients-kidney-disease.html#j
Timely receipt of care from a kidney specialist over the course of CKD is crucial for slowing the disease, improving survival while on long-term dialysis, and increasing the likelihood of receiving a kidney transplant. And while clinical guidelines recommend that all patients in later stages of CKD be under the care of kidney specialists, 25% to 50% of patients on dialysis in the United States had not received such care before they developed kidney failure, or end-stage renal disease (ESRD). Also, black patients with CKD are less likely to receive optimal kidney care and are more likely to develop ESRD than white patients. Guofen Yan, PhD (University of Virginia School of Medicine) and her colleagues wondered whether geography plays any role in access to pre–ESRD care among black and white CKD patients. They analyzed information from 404,622 white and black adult patients receiving dialysis between 2005 and 2010 and residing in 3,076 counties across the United States. The counties were grouped into large metropolitan, medium/small metropolitan, suburban, and rural counties. Among the major findings: Fewer patients received kidney specialist care for more than 12 months before developing ESRD in large-metro (25.7%) and rural (26.9%) counties than in medium/small-metro counties (31.6%). In all four geographic areas, black patients received less pre-ESRD care than their white counterparts. In large-metro counties, black patients were 27% less likely than whites to receive kidney specialist care for more than 12 months before developing ESRD. In rural counties, they were 16% less likely. In suburban and rural counties, black patients were 30% to 52% less likely than whites to see a dietitian before developing ESRD. "These significant geographic differences in receiving pre-ESRD care and the substantially large racial differences in certain geographic areas highlight the complexity of the issue, and may explain in part the limited progress in improving racial disparities in kidney disease care and outcomes," said Dr. Yan. "Our findings suggest improving receipt of key pre-ESRD care will require more refined regional characterization of health care needs," she added. In an accompanying editorial, Kevin Abbott, MD, Robert Nee, MD, and Christina Yuan, MD (Walter Reed National Military Medical Center) stated that Dr. Yan and colleagues' key finding "is that healthcare policies directed at eliminating pre-ESRD care disparities will not necessarily make 'the crooked way straight.' The way forward is likely to be anything but 'straightforward'—but there are potential investigative and intervention tools available." For example, they pointed to the use of geospatial analysis to quantify current and future healthcare needs in high risk regions and to identify mismatches between needs and available resources. Also, telemedicine could potentially improve access to quality care to otherwise isolated communities, either rural or urban, they wrote.

Read more at: http://medicalxpress.com/news/2013-03-geographic-affect-patients-kidney-disease.html#jCp
Timely receipt of care from a kidney specialist over the course of CKD is crucial for slowing the disease, improving survival while on long-term dialysis, and increasing the likelihood of receiving a kidney transplant. And while clinical guidelines recommend that all patients in later stages of CKD be under the care of kidney specialists, 25% to 50% of patients on dialysis in the United States had not received such care before they developed kidney failure, or end-stage renal disease (ESRD). Also, black patients with CKD are less likely to receive optimal kidney care and are more likely to develop ESRD than white patients. Guofen Yan, PhD (University of Virginia School of Medicine) and her colleagues wondered whether geography plays any role in access to pre–ESRD care among black and white CKD patients. They analyzed information from 404,622 white and black adult patients receiving dialysis between 2005 and 2010 and residing in 3,076 counties across the United States. The counties were grouped into large metropolitan, medium/small metropolitan, suburban, and rural counties. Among the major findings: Fewer patients received kidney specialist care for more than 12 months before developing ESRD in large-metro (25.7%) and rural (26.9%) counties than in medium/small-metro counties (31.6%). In all four geographic areas, black patients received less pre-ESRD care than their white counterparts. In large-metro counties, black patients were 27% less likely than whites to receive kidney specialist care for more than 12 months before developing ESRD. In rural counties, they were 16% less likely. In suburban and rural counties, black patients were 30% to 52% less likely than whites to see a dietitian before developing ESRD. "These significant geographic differences in receiving pre-ESRD care and the substantially large racial differences in certain geographic areas highlight the complexity of the issue, and may explain in part the limited progress in improving racial disparities in kidney disease care and outcomes," said Dr. Yan. "Our findings suggest improving receipt of key pre-ESRD care will require more refined regional characterization of health care needs," she added. In an accompanying editorial, Kevin Abbott, MD, Robert Nee, MD, and Christina Yuan, MD (Walter Reed National Military Medical Center) stated that Dr. Yan and colleagues' key finding "is that healthcare policies directed at eliminating pre-ESRD care disparities will not necessarily make 'the crooked way straight.' The way forward is likely to be anything but 'straightforward'—but there are potential investigative and intervention tools available." For example, they pointed to the use of geospatial analysis to quantify current and future healthcare needs in high risk regions and to identify mismatches between needs and available resources. Also, telemedicine could potentially improve access to quality care to otherwise isolated communities, either rural or urban, they wrote.

Read more at: http://medicalxpress.com/news/2013-03-geographic-affect-patients-kidney-disease.html#jCp
Timely receipt of care from a kidney specialist over the course of CKD is crucial for slowing the disease, improving survival while on long-term dialysis, and increasing the likelihood of receiving a kidney transplant. And while clinical guidelines recommend that all patients in later stages of CKD be under the care of kidney specialists, 25% to 50% of patients on dialysis in the United States had not received such care before they developed kidney failure, or end-stage renal disease (ESRD). Also, black patients with CKD are less likely to receive optimal kidney care and are more likely to develop ESRD than white patients. Guofen Yan, PhD (University of Virginia School of Medicine) and her colleagues wondered whether geography plays any role in access to pre–ESRD care among black and white CKD patients. They analyzed information from 404,622 white and black adult patients receiving dialysis between 2005 and 2010 and residing in 3,076 counties across the United States. The counties were grouped into large metropolitan, medium/small metropolitan, suburban, and rural counties. Among the major findings: Fewer patients received kidney specialist care for more than 12 months before developing ESRD in large-metro (25.7%) and rural (26.9%) counties than in medium/small-metro counties (31.6%). In all four geographic areas, black patients received less pre-ESRD care than their white counterparts. In large-metro counties, black patients were 27% less likely than whites to receive kidney specialist care for more than 12 months before developing ESRD. In rural counties, they were 16% less likely. In suburban and rural counties, black patients were 30% to 52% less likely than whites to see a dietitian before developing ESRD. "These significant geographic differences in receiving pre-ESRD care and the substantially large racial differences in certain geographic areas highlight the complexity of the issue, and may explain in part the limited progress in improving racial disparities in kidney disease care and outcomes," said Dr. Yan. "Our findings suggest improving receipt of key pre-ESRD care will require more refined regional characterization of health care needs," she added. In an accompanying editorial, Kevin Abbott, MD, Robert Nee, MD, and Christina Yuan, MD (Walter Reed National Military Medical Center) stated that Dr. Yan and colleagues' key finding "is that healthcare policies directed at eliminating pre-ESRD care disparities will not necessarily make 'the crooked way straight.' The way forward is likely to be anything but 'straightforward'—but there are potential investigative and intervention tools available." For example, they pointed to the use of geospatial analysis to quantify current and future healthcare needs in high risk regions and to identify mismatches between needs and available resources. Also, telemedicine could potentially improve access to quality care to otherwise isolated communities, either rural or urban, they wrote.

Read more at: http://medicalxpress.com/news/2013-03-geographic-affect-patients-kidney-disease.html#jCp
Timely receipt of care from a kidney specialist over the course of CKD is crucial for slowing the disease, improving survival while on long-term dialysis, and increasing the likelihood of receiving a kidney transplant. And while clinical guidelines recommend that all patients in later stages of CKD be under the care of kidney specialists, 25% to 50% of patients on dialysis in the United States had not received such care before they developed kidney failure, or end-stage renal disease (ESRD). Also, black patients with CKD are less likely to receive optimal kidney care and are more likely to develop ESRD than white patients. Guofen Yan, PhD (University of Virginia School of Medicine) and her colleagues wondered whether geography plays any role in access to pre–ESRD care among black and white CKD patients. They analyzed information from 404,622 white and black adult patients receiving dialysis between 2005 and 2010 and residing in 3,076 counties across the United States. The counties were grouped into large metropolitan, medium/small metropolitan, suburban, and rural counties. Among the major findings: Fewer patients received kidney specialist care for more than 12 months before developing ESRD in large-metro (25.7%) and rural (26.9%) counties than in medium/small-metro counties (31.6%). In all four geographic areas, black patients received less pre-ESRD care than their white counterparts. In large-metro counties, black patients were 27% less likely than whites to receive kidney specialist care for more than 12 months before developing ESRD. In rural counties, they were 16% less likely. In suburban and rural counties, black patients were 30% to 52% less likely than whites to see a dietitian before developing ESRD. "These significant geographic differences in receiving pre-ESRD care and the substantially large racial differences in certain geographic areas highlight the complexity of the issue, and may explain in part the limited progress in improving racial disparities in kidney disease care and outcomes," said Dr. Yan. "Our findings suggest improving receipt of key pre-ESRD care will require more refined regional characterization of health care needs," she added. In an accompanying editorial, Kevin Abbott, MD, Robert Nee, MD, and Christina Yuan, MD (Walter Reed National Military Medical Center) stated that Dr. Yan and colleagues' key finding "is that healthcare policies directed at eliminating pre-ESRD care disparities will not necessarily make 'the crooked way straight.' The way forward is likely to be anything but 'straightforward'—but there are potential investigative and intervention tools available." For example, they pointed to the use of geospatial analysis to quantify current and future healthcare needs in high risk regions and to identify mismatches between needs and available resources. Also, telemedicine could potentially improve access to quality care to otherwise isolated communities, either rural or urban, they wrote.

Read more at: http://medicalxpress.com/news/2013-03-geographic-affect-patients-kidney-disease.html#jCp

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