Factors Considered by Nephrologists in Excluding Patients from Kidney Transplant Referral
Background: Provider perceptions about patient candidacy for kidney transplant (KT) are potentially significant contributors to disparities in KT. Objective: To examine nephrologists’ perceptions about factors that are important in excluding patients from KT referral, and to analyze the association...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Shiraz University of Medical Sciences
2019-07-01
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| Series: | International Journal of Organ Transplantation Medicine |
| Subjects: | |
| Online Access: | http://www.ijotm.com/ojs/index.php/IJOTM/article/view/664 |
| _version_ | 1818043131014152192 |
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| author | K Bartolomeo A Gandhir M Lipinski J Romeu Nasrollah Ghahramani |
| author_facet | K Bartolomeo A Gandhir M Lipinski J Romeu Nasrollah Ghahramani |
| author_sort | K Bartolomeo |
| collection | DOAJ |
| description | Background: Provider perceptions about patient candidacy for kidney transplant (KT) are potentially significant contributors to disparities in KT.
Objective: To examine nephrologists’ perceptions about factors that are important in excluding patients from KT referral, and to analyze the association between these perceptions and nephrologists’ demographic and practice characteristics.
Methods: Invitations were sent to 3180 nephrologists. Among those who consented, 822 fulfilled the inclusion criteria, and 250 were randomly invited to complete a questionnaire about perceptions of factors essential in deciding not to refer patients for KT.
Results: Responses from 216 participants with complete responses were analyzed. The 3 most common reasons for excluding patients were “patient’s inadequate social support” (44%), “limited understanding of the process due to patient’s inadequate education” (32%), and “patient’s age above 65” (26%). Nephrologists practicing in rural settings were more likely to consider inadequate support and limited education of patients as reasons not to refer for KT. In multivariate analysis, physicians with 2 or fewer transplant centers within 50 miles were more likely to report inadequate social support (OR: 3.15, 95% CI: 1.59–6.24) and age greater than 65 years (OR: 1.88, 95% CI: 1.01–3.49) as reasons to exclude patients from KT referral. Nephrologists whose practice included patients majority of whom had not completed high school were more likely to consider limited understanding due to inadequate education as an important reason to exclude patients from KT (OR: 3.31, 95% CI: 1.60–6.86).
Conclusion: Patient’s social support, understanding, and age were the most common factors regarded by nephrologists as important in not referring patients for KT evaluation. Practice location, particularly rural setting, proximity to a transplant center, and the education level of a nephrologist’s patient population were important determinants of referral for KT. |
| first_indexed | 2024-12-10T08:57:20Z |
| format | Article |
| id | doaj.art-7f211f32a99b41eaaff509616097ef04 |
| institution | Directory Open Access Journal |
| issn | 2008-6482 2008-6490 |
| language | English |
| last_indexed | 2024-12-10T08:57:20Z |
| publishDate | 2019-07-01 |
| publisher | Shiraz University of Medical Sciences |
| record_format | Article |
| series | International Journal of Organ Transplantation Medicine |
| spelling | doaj.art-7f211f32a99b41eaaff509616097ef042022-12-22T01:55:22ZengShiraz University of Medical SciencesInternational Journal of Organ Transplantation Medicine2008-64822008-64902019-07-01103304Factors Considered by Nephrologists in Excluding Patients from Kidney Transplant ReferralK Bartolomeo0A Gandhir1M Lipinski2J Romeu3Nasrollah Ghahramani4Division of Nephrology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USADivision of Nephrology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USADivision of Nephrology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USADivision of Nephrology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USADivision of Nephrology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USABackground: Provider perceptions about patient candidacy for kidney transplant (KT) are potentially significant contributors to disparities in KT. Objective: To examine nephrologists’ perceptions about factors that are important in excluding patients from KT referral, and to analyze the association between these perceptions and nephrologists’ demographic and practice characteristics. Methods: Invitations were sent to 3180 nephrologists. Among those who consented, 822 fulfilled the inclusion criteria, and 250 were randomly invited to complete a questionnaire about perceptions of factors essential in deciding not to refer patients for KT. Results: Responses from 216 participants with complete responses were analyzed. The 3 most common reasons for excluding patients were “patient’s inadequate social support” (44%), “limited understanding of the process due to patient’s inadequate education” (32%), and “patient’s age above 65” (26%). Nephrologists practicing in rural settings were more likely to consider inadequate support and limited education of patients as reasons not to refer for KT. In multivariate analysis, physicians with 2 or fewer transplant centers within 50 miles were more likely to report inadequate social support (OR: 3.15, 95% CI: 1.59–6.24) and age greater than 65 years (OR: 1.88, 95% CI: 1.01–3.49) as reasons to exclude patients from KT referral. Nephrologists whose practice included patients majority of whom had not completed high school were more likely to consider limited understanding due to inadequate education as an important reason to exclude patients from KT (OR: 3.31, 95% CI: 1.60–6.86). Conclusion: Patient’s social support, understanding, and age were the most common factors regarded by nephrologists as important in not referring patients for KT evaluation. Practice location, particularly rural setting, proximity to a transplant center, and the education level of a nephrologist’s patient population were important determinants of referral for KT.http://www.ijotm.com/ojs/index.php/IJOTM/article/view/664Health status disparitiesKidneyNephrologistPerceptionsReferral and consultationLife support systemsTransplantRural populationUrban population |
| spellingShingle | K Bartolomeo A Gandhir M Lipinski J Romeu Nasrollah Ghahramani Factors Considered by Nephrologists in Excluding Patients from Kidney Transplant Referral International Journal of Organ Transplantation Medicine Health status disparities Kidney Nephrologist Perceptions Referral and consultation Life support systems Transplant Rural population Urban population |
| title | Factors Considered by Nephrologists in Excluding Patients from Kidney Transplant Referral |
| title_full | Factors Considered by Nephrologists in Excluding Patients from Kidney Transplant Referral |
| title_fullStr | Factors Considered by Nephrologists in Excluding Patients from Kidney Transplant Referral |
| title_full_unstemmed | Factors Considered by Nephrologists in Excluding Patients from Kidney Transplant Referral |
| title_short | Factors Considered by Nephrologists in Excluding Patients from Kidney Transplant Referral |
| title_sort | factors considered by nephrologists in excluding patients from kidney transplant referral |
| topic | Health status disparities Kidney Nephrologist Perceptions Referral and consultation Life support systems Transplant Rural population Urban population |
| url | http://www.ijotm.com/ojs/index.php/IJOTM/article/view/664 |
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