Anderson Amanda H, Cohen Andrew J, Kutner Nancy G, Kopp Jeffrey B, Kimmel Paul L, Muntner Paul
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Los Angeles, USA; Department of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Department of Medicine, Section of Nephrology, Ochsner Health System, New Orleans, Los Angeles, USA.
Kidney Int. 2009 Jun;75(11):1202-1208. doi: 10.1038/ki.2009.5. Epub 2009 Feb 11.
In order to evaluate the factors that contributed to missed dialysis sessions and increased hospitalizations of hemodialysis patients after Hurricane Katrina, we contacted 386 patients from 9 New Orleans hemodialysis units. Data were collected through structured telephone interviews on socio-demographics, dialysis factors, and evacuation characteristics. Overall, 44% of patients reported missing at least one and almost 17% reported missing 3 or more dialysis sessions. The likelihood of missing 3 or more sessions was greater for those whose dialysis vintage was less than 2 years compared to those for whom it was 5 or more years, who had 38 or fewer billed dialysis sessions compared to those who had 39 or more in the 3 months before the storm, who lived alone before the storm, who were unaware of their dialysis facility's emergency plans, who did not evacuate prior to hurricane landfall, and who were placed in a shelter. The adjusted odds ratio of hospitalization among patients who missed 3 or more compared to those who did not miss any dialysis sessions was 2.16 (95% CI: 1.05-4.43). These findings suggest that when preparing for future disasters more emphasis needs to be placed on patient awareness and early execution of emergency plans.
为了评估导致卡特里娜飓风过后血液透析患者错过透析疗程以及住院率增加的因素,我们联系了新奥尔良9个血液透析单位的386名患者。通过结构化电话访谈收集了有关社会人口统计学、透析因素和疏散特征的数据。总体而言,44%的患者报告至少错过一次透析疗程,近17%的患者报告错过3次或更多透析疗程。透析时间少于2年的患者相比透析时间为5年或更长时间的患者,风暴前3个月计费透析疗程为38次或更少的患者相比39次或更多的患者,风暴前独居的患者,不了解其透析机构应急计划的患者,飓风登陆前未撤离的患者以及被安置在避难所的患者,错过3次或更多疗程的可能性更大。错过3次或更多疗程的患者与未错过任何透析疗程的患者相比,住院的调整比值比为2.16(95%置信区间:1.05 - 4.43)。这些发现表明,在为未来灾难做准备时,需要更加重视患者的认知以及应急计划的早期执行。