Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.
Programming and Management Control Service, Unit of Controls, St. Anna University-Hospital, Ferrara, Italy.
Front Public Health. 2023 Jun 2;11:1158387. doi: 10.3389/fpubh.2023.1158387. eCollection 2023.
Psychosocial factors frequently occur in kidney transplant recipients (KTRs), leading to behavioral alterations and reduced therapeutic adherence. However, the burden of psychosocial disorders on costs for KTRs is unknown. The aim of the study is to identify predictors of healthcare costs due to hospital admissions and emergency department access in KTRs.
This is a longitudinal observational study conducted on KTRs aged >18 years, excluding patients with an insufficient level of autonomy and cognitive disorder. KTRs underwent psychosocial assessment via two interviews, namely the Mini-International Neuropsychiatric Interview 6.0 (MINI 6.0) and the Diagnostic Criteria for Psychosomatic Research Interview (DCPR) and via the Edmonton Symptom Assessment System Revised (ESAS-R) scale, a self-administrated questionnaire. Sociodemographic data and healthcare costs for hospital admissions and emergency department access were collected in the 2016-2021 period. Psychosocial determinants were as follows: (1) ESAS-R psychological and physical score; (2) symptomatic clusters determined by DCPR (illness behavior cluster, somatization cluster, and personological cluster); and (3) ICD diagnosis of adjustment disorder, anxiety disorder, and mood disorder. A multivariate regression model was used to test the association between psychosocial determinants and total healthcare costs.
A total of 134 KTRs were enrolled, of whom 90 (67%) were men with a mean age of 56 years. A preliminary analysis of healthcare costs highlighted that higher healthcare costs are correlated with worse outcomes and death ( < 0.001). Somatization clusters ( = 0.020) and mood disorder ( < 0.001) were positively associated with costs due to total healthcare costs.
This study showed somatization and mood disorders could predict costs for hospital admissions and emergency department access and be possible risk factors for poor outcomes, including death, in KTRs.
心理社会因素在肾移植受者（KTR）中经常出现，导致行为改变和治疗依从性降低。然而，心理社会障碍对 KTR 成本的负担尚不清楚。本研究旨在确定导致 KTR 住院和急诊就诊的医疗保健成本的预测因素。
这是一项对年龄>18 岁的 KTR 进行的纵向观察性研究，排除了自主能力不足和认知障碍的患者。通过两次访谈（Mini-International Neuropsychiatric Interview 6.0（MINI 6.0）和诊断标准为心理生理研究访谈（DCPR））以及自我管理问卷埃德蒙顿症状评估系统修订版（ESAS-R）对 KTR 进行心理社会评估。收集了 2016-2021 年期间住院和急诊就诊的社会人口统计学数据和医疗保健费用。心理社会决定因素如下：（1）ESAS-R 心理和生理评分；（2）DCPR 确定的症状群（疾病行为群、躯体化群和人格群）；和（3）调整障碍、焦虑障碍和心境障碍的 ICD 诊断。使用多元回归模型来测试心理社会决定因素与总医疗保健费用之间的关联。
共纳入 134 名 KTR，其中 90 名（67%）为男性，平均年龄为 56 岁。对医疗保健费用的初步分析表明，更高的医疗保健费用与更差的结果和死亡相关（<0.001）。躯体化群（=0.020）和心境障碍（<0.001）与总医疗保健费用相关的费用呈正相关。
本研究表明躯体化和心境障碍可以预测住院和急诊就诊的费用，并且可能是 KTR 不良结局（包括死亡）的危险因素。
