Tuesday, 27 July 2010

Location, again

And further to the American report (below), a UK newspaper is reporting on the findings of a study which shows that in some areas of the UK, a quarter of patients are put on the transplant waiting list within two years of starting their kidney dialysis treatment, while in other areas more than two thirds are on the list within two years. And that this can not be explained by differences in their state of health.

It looks like the usual, infamous, postcode lottery effect once again. Treatment doesn't depend on your health but your address.

Thursday, 15 July 2010

Location, location, location

So what should determine your priority for dialysis treatment? Your current state of health or your current state of residence? According to a recent news alert from Stanford University, it's your place of residence, more often than not.

The type and intensity of treatment older Americans receive for kidney failure depends on the region where they receive care rather than on evidence-based practice guidelines and patient preferences, according to a study to be published in the July 14 Journal of the American Medical Association.

There are pronounced regional differences in treatment practices for older adults with kidney failure, including decisions about starting or stopping dialysis, that don't seem to be explained by differences in patient characteristics, said Manjula Kurella Tamura, MD, senior author of the study and assistant professor of nephrology at the Stanford University School of Medicine.

The report says that many important decisions are more likely to be influenced by where you live rather than the patient's actual needs.

In the UK they call this sort of thing "postcode lottery", and it affects all sorts of health care problems. People have been known to move house, just to get treatment.

The researchers found another, rather unexpected, result. Some areas spend much more on health care and have a higher density of nephrologists — physicians specializing in kidney disease. But despite this, patients with kidney failure in these areas were less likely to have seen a nephrologist before starting dialysis! And more amazingly, patients in the higher spending areas didn't actually fair any better than those in the other areas.

You might want to read the news alert as it does seem a strange set of results.

In my opinion, it's almost as if the specialists move to the areas that spend most, but don't necessarily give value for money treatment.