Dr Johanna Birrell1,2, Prof Angela Webster2,3, Dr Nicholas Cross1,2, Mr Andrew Kindon4,5, Dr Matthew Hobbs4,5, Dr James Hedley2, Prof Tim Driscoll2, Dr Nicole De La Mata2
1Christchurch Hospital, , Aotearoa / New Zealand, 2School of Public Health, University of Sydney, Sydney, Australia, 3Department of Renal Medicine, Westmead Hospital, Sydney, Australia, 4GeoHealth Laboratory, Te Taiwhenua O Te Hauora, University of Canterbury, Te Whare Wānanga O Waitaha, Christchurch, Aotearoa / New Zealand, 5Faculty of Health, Te Kaupeka Oranga, University of Canterbury, Te Whare Wānanga O Waitaha, Christchurch, Aotearoa / New Zealand
Biography:
Johanna completed this research while working as the Ross Bailey Nephrology Fellow at Christchurch Hospital in 2023, as the final run of her general physician training. She is currently on maternity leave with her two kids.
Abstract:
Background:
Prolonged travel time to receive dialysis is associated with decreased quality of life and increased mortality. However, patient travel time is rarely systematically analysed during health service planning.
Aims:
(1) Examine spatio-temporal trends in travel time for people commencing dialysis in Aotearoa New Zealand (NZ); (2) assess the relationship between travel time and dialysis modality; and (3) create interactive nationwide maps to support renal service planning.
Methods:
AcceSS and Equity in Treatment for kidney disease (ASSET), a health-linked data platform, was used to include all people commencing dialysis in NZ from 2006-19 (N=6,690). Patients’ driving times from their residential location to the nearest haemodialysis unit were estimated using geospatial software. Multiple logistic regression modelling explored the association between travel time and dialysis modality, adjusting for demographic, clinical and service factors.
Results:
Median one-way driving time was 14 minutes (IQI:8-31) and was significantly higher for patients living in rural (45 minutes [IQI:28-62]) than urban areas (11 minutes [IQI:8-18]; p<0.001). Patients living farther from a unit were independently less likely to receive in-centre haemodialysis (OR 0.82 [95%CI:0.68-0.99] for driving time 20-29 minutes; 0.62 [95%CI:0.52-0.72] for ≥30; reference <10), as were those in regions with greater haemodialysis unit capacity pressure. Our interactive maps demonstrate marked inter-regional variation in dialysis modality, patient travel time and unit capacity.
Conclusions:
Innovative service design is needed to reduce the burden of travel time, particularly for rural dialysis patients. We present novel geospatial techniques to support dialysis service planning that is targeted to areas of greatest need.