Mann Shawna, Naylor Kyla L, McArthur Eric, Kim S Joseph, Knoll Greg, Zaltzman Jeffrey, Treleaven Darin, Ouedraogo Alexandra, Jevnikar Anthony, Garg Amit X
Division of Nephrology, Western University, London, ON, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada.
Can J Kidney Health Dis. 2020 Jan 25;7:2054358119898552. doi: 10.1177/2054358119898552. eCollection 2020.
In Ontario, kidney transplants have risen by 4% annually in recent years. An understanding of how this will affect the future annual number of posttransplant follow-up visits informs how to organize and deliver care.
We projected the required number of annual posttransplant follow-up nephrology visits to inform posttransplant care delivery.
Population-based retrospective cohort study.
Linked databases from Ontario, Canada (population 14 million).
Incident kidney transplant recipients from years 2008 to 2013.
Frequency, distance traveled, and current and projected visits for posttransplant follow-up.
Assuming a graft survival of 13 years and using the mean number of posttransplant clinic visits in years 1, 2, and 3, we forecasted the number of clinic visits needed in the year 2027.
Using data from 2443 recipients, the mean (SD) number of clinic visits per recipient was 14.0 (9.2) in the first year after transplant, and 3.9 (6.2) and 3.0 (5.3) in the second and third year, respectively. If transplant rates rise by 4% per year until 2027, the estimated annual visits number will increase from 30 622 to 43 948. The median (25th, 75th percentile) distance between transplant center and patient's home was 30 (13, 65) km. The median round-trip travel distance for these visits in the first year after transplantation was 603 km per recipient, and median driving cost was Can$344 (2017).
Regarding patient expense, limitations include that distances traveled were calculated orthodromically, and we did not account for patient cost of follow-up beyond that of vehicular travel. Regarding follow-up projections, limitations include the assumption that graft life span will not change, follow-up patterns do not differ between donor kidney type, and we did not survey stakeholders as to their preferred method of follow-up.
We quantified the increase in posttransplant visits when regional annual rates of transplantation rise. Strategies recognizing the burden of these visits may enhance patient-centered care, as it is unclear how some patients manage costs, nor how the current health care system will manage the demand.
近年来，安大略省的肾移植数量每年增长4%。了解这将如何影响未来每年移植后随访就诊的数量，有助于指导如何组织和提供护理。
我们预测了每年移植后随访所需的肾病就诊次数，以指导移植后护理的提供。
基于人群的回顾性队列研究。
来自加拿大安大略省的关联数据库（人口1400万）。
2008年至2013年的新发肾移植受者。
移植后随访的频率、行程距离以及当前和预测的就诊次数。
假设移植物存活13年，并使用第1、2和3年移植后门诊就诊的平均次数，我们预测了2027年所需的门诊就诊次数。
利用2443名受者的数据，每位受者在移植后第一年的门诊就诊平均（标准差）次数为14.0（9.2）次，第二年和第三年分别为3.9（6.2）次和3.0（5.3）次。如果移植率到2027年每年上升4%，预计每年的就诊次数将从30622次增加到43948次。移植中心与患者家庭之间的中位（第25、75百分位数）距离为30（13，65）公里。移植后第一年这些就诊的中位往返行程距离为每位受者603公里，中位驾车成本为344加元（2017年）。
关于患者费用，局限性包括行程距离是按直线计算的，并且我们没有考虑患者随访的费用，除了驾车费用之外。关于随访预测，局限性包括假设移植物寿命不会改变，不同供肾类型的随访模式没有差异，并且我们没有就他们首选的随访方法对利益相关者进行调查。
我们量化了区域年移植率上升时移植后就诊次数的增加。认识到这些就诊负担的策略可能会加强以患者为中心的护理，因为目前尚不清楚一些患者如何管理费用，也不清楚当前的医疗保健系统将如何应对需求。
