Loesch Gustavo, Cruz June A W, Pecoits-Filho Roberto, Figueiredo Ana E, Barretti Pasqual, de Moraes Thyago P
Programa de Pós-Graduação em Ciências da Saúde da Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.
Programa de Pós-Graduação em Administração da Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.
Clin Kidney J. 2020 Jul 16;13(6):1012-1016. doi: 10.1093/ckj/sfaa118. eCollection 2020 Dec.
End-stage kidney disease (ESKD) treatment is very costly and accounts for a significant percentage of public healthcare expenditures. Beyond direct costs, dialysis patients use other healthcare levels, but the impact of public investment on each of these levels is unclear. This study aimed to investigate the association between direct financing at different healthcare levels and overall mortality in peritoneal dialysis (PD) patients.
We included all adult incident PD patients from a Brazilian prospective, nationwide PD cohort. Overall mortality was the primary outcome of interest. We used a three-level multilevel survival analysis to investigate whether mortality was associated with the investments destined to different levels of healthcare complexity: (i) primary, (ii) medium and high and (iii) professional healthcare training and community awareness.
We evaluated 5707 incident PD patients from 78 Brazilian cities, which were divided into four quartiles for each healthcare level (Groups I-IV). After taking the highest quartile (Group IV) as a reference, investment in the primary health level was not associated with patient survival. Otherwise, medium and high complexity levels were associated with higher mortality risk. Also, investment in healthcare manager training and community awareness had an impact on patient survival.
Investments in different levels of the healthcare system have distinct impacts on PD patient survival. Investment in healthcare manager training and community awareness seems to be a promising strategy on which to focus, given the relatively low cost and positive impact on outcome.
终末期肾病（ESKD）的治疗成本非常高昂，在公共医疗支出中占很大比例。除了直接成本外，透析患者还使用其他医疗服务层级，但公共投资对这些层级中每一层级的影响尚不清楚。本研究旨在调查不同医疗服务层级的直接融资与腹膜透析（PD）患者总体死亡率之间的关联。
我们纳入了巴西一项前瞻性全国性PD队列中的所有成年新发PD患者。总体死亡率是主要关注的结局。我们采用三级多水平生存分析来调查死亡率是否与针对不同医疗复杂程度层级的投资相关：（i）初级，（ii）中高级，以及（iii）专业医疗培训和社区认知。
我们评估了来自巴西78个城市的5707例新发PD患者，每个医疗服务层级分为四个四分位数（I - IV组）。以最高四分位数（IV组）为参照，对初级卫生层级的投资与患者生存率无关。相反，中高复杂程度层级与更高的死亡风险相关。此外，对医疗管理人员培训和社区认知的投资对患者生存率有影响。
医疗系统不同层级的投资对PD患者生存率有不同影响。鉴于成本相对较低且对结局有积极影响，对医疗管理人员培训和社区认知的投资似乎是一个值得关注的有前景的策略。
