IMPACT OF TRAVEL TIME ON DIALYSIS MODALITY IN AOTEAROA NEW ZEALAND
Dr Johanna Birrell1, Dr Nicholas Cross1,2, Mr Andrew Kindon3, Dr Matthew Hobbs3, Mr James Hedley1, Prof Angela Webster1,4, Prof Tim Driscoll1, Dr Nicole De La Mata1
1University Of Sydney School Of Public Health, Camperdown, Australia, 2Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand, 3GeoHealth Laboratory – Te Taiwhenua o te Hauora, Christchurch, New Zealand, 4Westmead Hospital, Sydney, Australia
Aim: To assess the impact of travel time to a haemodialysis unit on dialysis modality in Aotearoa New Zealand (NZ).
Background: An increasing number of people are receiving dialysis in NZ, requiring development of new dialysis facilities to meet capacity demands. How the establishment of new centres has affected travel time, clinician recommendations and patient choices (of home therapy with peritoneal dialysis/home haemodialysis, or in-centre haemodialysis) is uncertain. An understanding of these relationships is required for service planning, including minimising ‘time toxicity’ for patients and modelling dialysis capacity requirements.
Methods: We used AcceSS and Equity in Transplantation (ASSET), a health-linked data platform, to include people commencing dialysis in NZ from 2006-19. Population-weighted centroid coordinates were assigned using residential domicile. Patients’ driving times to their nearest regional haemodialysis unit were estimated using geo-spatial software.
Multiple logistic regression was used to model predictors of home therapy versus in-centre haemodialysis at one year after dialysis commencement, adjusting for socio-demographic factors and comorbidities.
Results: From 2006-19, 10 new haemodialysis unit locations opened across NZ. For our cohort of 6,690 people commencing dialysis, shorter driving time was independently associated with higher likelihood of receiving in-centre haemodialysis at one year, as were older age, ethnicity, geographic region, multimorbidity, obesity and late referral. Median driving time to the nearest unit decreased from 17.5 (interquartile interval (IQI):9.6-37.4) to 11.6 (IQI:7.1-22.4) minutes. The percentage of patients receiving in-centre haemodialysis increased from 41% to 53% over the study period. Interactive maps have been developed to highlight spatio-temporal changes in travel time and dialysis modality.
Conclusions: Travel time is a key predictor of patients’ dialysis modality and an important factor in future haemodialysis unit capacity planning.
Biography:
Johanna is a General Physician and Advanced Trainee in Public Health Medicine. Johanna is currently living in Darwin, NT and is undertaking a PhD through the University of Sydney School of Public Health.