Winnipeg, Manitoba R3A 1R9, Canada.
Clin J Am Soc Nephrol. 2010 Apr;5(4):645-51. doi: 10.2215/CJN.04550709. Epub 2010 Feb 25.
Remotely located patients not living close to a nephrologist present major challenges for providing care. Various models of remotely delivered care have been developed, with a gap in knowledge regarding the outcomes of these heterogeneous models. This report describes a satellite care model for remote full-care hemodialysis units managed homogenously in the province of Manitoba, Canada, without onsite nephrologists. Survival in remotely located full-care units is compared with a large, urban full-care center with onsite nephrologists.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data from a Canadian provincial dialysis registry were extracted on 2663 patients between 1990 and 2005. All-cause mortality after initiation of chronic hemodialysis was assessed with Cox proportional hazards regression. Both short-term (1 year) and long-term (2 to 5 years) survival were analyzed.
Survival for patients receiving remotely delivered care was shown to be better than for those receiving care in the urban care center with this particular Canadian model of care. Furthermore, there was no difference when assessing short- and long-term survival. This was independent of distance from the urban center.
Chronic hemodialysis patients receiving remotely delivered care in a specialized facility attain comparable, if not better survival outcomes than their urban counterparts with direct onsite nephrology care. This model can potentially be adapted to other underserviced areas, including increasingly larger urban centers.
对于那些居住在远离肾病医生的偏远地区的患者来说，提供医疗护理面临着重大挑战。已经开发出了各种远程护理模式，但对于这些不同模式的结果，我们的了解还存在空白。本报告描述了一种在加拿大马尼托巴省的远程全护血液透析单位中使用的卫星护理模式，这些单位由统一管理，没有现场肾病医生。将远程全护单位的生存情况与一个拥有现场肾病医生的大型城市全护中心进行比较。
设计、设置、参与者和测量：1990 年至 2005 年间，从加拿大一个省级透析登记处提取了 2663 名患者的数据。采用 Cox 比例风险回归评估慢性血液透析开始后全因死亡率。分析了短期（1 年）和长期（2 至 5 年）的生存率。
使用这种特定的加拿大护理模式，接受远程护理的患者的生存率好于在城市护理中心接受护理的患者。此外，在评估短期和长期生存率时，结果也是如此。这与离城市中心的距离无关。
在专门设施中接受远程护理的慢性血液透析患者，其生存结果与在城市中心接受直接现场肾病护理的患者相当，甚至更好。这种模式可以潜在地适用于其他服务不足的地区，包括越来越大的城市中心。
