Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals
Abstract Background Chronic kidney disease (CKD) is increasing worldwide, and the majority of the CKD burden is in low- and middle-income countries (LMICs). However, there is wide variability in global access to kidney care therapies such as dialysis and kidney transplantation. The challenges health...
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| Format: | Article |
| Language: | English |
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BMC
2020-02-01
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| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12882-020-01732-w |
| _version_ | 1818438718905647104 |
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| author | David Flood Katharine Wilcox Andrea Aguilar Ferro Carlos Mendoza Montano Joaquin Barnoya Pablo Garcia Randall Lou-Meda Peter Rohloff Anita Chary |
| author_facet | David Flood Katharine Wilcox Andrea Aguilar Ferro Carlos Mendoza Montano Joaquin Barnoya Pablo Garcia Randall Lou-Meda Peter Rohloff Anita Chary |
| author_sort | David Flood |
| collection | DOAJ |
| description | Abstract Background Chronic kidney disease (CKD) is increasing worldwide, and the majority of the CKD burden is in low- and middle-income countries (LMICs). However, there is wide variability in global access to kidney care therapies such as dialysis and kidney transplantation. The challenges health professionals experience while providing kidney care in LMICs have not been well described. The goal of this study is to elicit health professionals’ perceptions of providing kidney care in a resource-constrained environment, strategies for dealing with resource limitations, and suggestions for improving kidney care in Guatemala. Methods Semi-structured interviews were performed with 21 health professionals recruited through convenience sampling at the largest public nephrology center in Guatemala. Health professionals included administrators, physicians, nurses, technicians, nutritionists, psychologists, laboratory personnel, and social workers. Interviews were recorded and transcribed in Spanish. Qualitative data from interviews were analyzed in NVivo using an inductive approach, allowing dominant themes to emerge from interview transcriptions. Results Health professionals most frequently described challenges in providing high-quality care due to resource limitations. Reducing the frequency of hemodialysis, encouraging patients to opt for peritoneal dialysis rather than hemodialysis, and allocating resources based on clinical acuity were common strategies for reconciling high demand and limited resources. Providers experienced significant emotional challenges related to high patient volume and difficult decisions on resource allocation, leading to burnout and moral distress. To improve care, respondents suggested increased budgets for equipment and personnel, investments in preventative services, and decentralization of services. Conclusions Health professionals at the largest public nephrology center in Guatemala described multiple strategies to meet the rising demand for renal replacement therapy. Due to systems-level limitations, health professionals faced difficult choices on the stewardship of resources that are linked to sentiments of burnout and moral distress. This study offers important lessons in Guatemala and other countries seeking to build capacity to scale-up kidney care. |
| first_indexed | 2024-12-14T17:45:02Z |
| format | Article |
| id | doaj.art-77bf16b277a9451f98fdf2db5d6d6745 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-14T17:45:02Z |
| publishDate | 2020-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-77bf16b277a9451f98fdf2db5d6d67452022-12-21T22:52:45ZengBMCBMC Nephrology1471-23692020-02-0121111010.1186/s12882-020-01732-wChallenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionalsDavid Flood0Katharine Wilcox1Andrea Aguilar Ferro2Carlos Mendoza Montano3Joaquin Barnoya4Pablo Garcia5Randall Lou-Meda6Peter Rohloff7Anita Chary8National Clinicians Scholars Program, Division of Hospital Medicine, University of MichiganWuqu’ Kawoq | Maya Health AllianceWuqu’ Kawoq | Maya Health AllianceInstitute of Nutrition of Central America and Panama (Instituto de Nutrición de Centroamérica y Panamá, INCAP)Unit for Cardiovascular Surgery (Unidad de Cirugía Cardiovascular de Guatemala, UNICAR)Division of Nephrology, Stanford UniversityFoundation for Children with Renal Disease (Fundación para el Niño Enfermo Renal, FUNDANIER)Wuqu’ Kawoq | Maya Health AllianceWuqu’ Kawoq | Maya Health AllianceAbstract Background Chronic kidney disease (CKD) is increasing worldwide, and the majority of the CKD burden is in low- and middle-income countries (LMICs). However, there is wide variability in global access to kidney care therapies such as dialysis and kidney transplantation. The challenges health professionals experience while providing kidney care in LMICs have not been well described. The goal of this study is to elicit health professionals’ perceptions of providing kidney care in a resource-constrained environment, strategies for dealing with resource limitations, and suggestions for improving kidney care in Guatemala. Methods Semi-structured interviews were performed with 21 health professionals recruited through convenience sampling at the largest public nephrology center in Guatemala. Health professionals included administrators, physicians, nurses, technicians, nutritionists, psychologists, laboratory personnel, and social workers. Interviews were recorded and transcribed in Spanish. Qualitative data from interviews were analyzed in NVivo using an inductive approach, allowing dominant themes to emerge from interview transcriptions. Results Health professionals most frequently described challenges in providing high-quality care due to resource limitations. Reducing the frequency of hemodialysis, encouraging patients to opt for peritoneal dialysis rather than hemodialysis, and allocating resources based on clinical acuity were common strategies for reconciling high demand and limited resources. Providers experienced significant emotional challenges related to high patient volume and difficult decisions on resource allocation, leading to burnout and moral distress. To improve care, respondents suggested increased budgets for equipment and personnel, investments in preventative services, and decentralization of services. Conclusions Health professionals at the largest public nephrology center in Guatemala described multiple strategies to meet the rising demand for renal replacement therapy. Due to systems-level limitations, health professionals faced difficult choices on the stewardship of resources that are linked to sentiments of burnout and moral distress. This study offers important lessons in Guatemala and other countries seeking to build capacity to scale-up kidney care.http://link.springer.com/article/10.1186/s12882-020-01732-wQualitative researchGlobal kidney careGlobal healthEnd-stage kidney diseaseBurnoutGuatemala |
| spellingShingle | David Flood Katharine Wilcox Andrea Aguilar Ferro Carlos Mendoza Montano Joaquin Barnoya Pablo Garcia Randall Lou-Meda Peter Rohloff Anita Chary Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals BMC Nephrology Qualitative research Global kidney care Global health End-stage kidney disease Burnout Guatemala |
| title | Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals |
| title_full | Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals |
| title_fullStr | Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals |
| title_full_unstemmed | Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals |
| title_short | Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals |
| title_sort | challenges in the provision of kidney care at the largest public nephrology center in guatemala a qualitative study with health professionals |
| topic | Qualitative research Global kidney care Global health End-stage kidney disease Burnout Guatemala |
| url | http://link.springer.com/article/10.1186/s12882-020-01732-w |
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