Evidence map›Paper›PMID 35440483›Full record

ArticleCMAJ open

Health system barriers and facilitators to living donor kidney transplantation: a qualitative case study in British Columbia.

Anna Horton, Peter Nugus, Marie-Chantal Fortin, David Landsberg, Marcelo Cantarovich, Shaifali Sandal

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ open. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed.

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  7. Conducting and Writing Quantitative and Qualitative Research.Journal of Korean medical science · 2023
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Anna HortonResearch Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que.
Peter NugusResearch Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que.
Marie-Chantal FortinResearch Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que.
David LandsbergResearch Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que.
Marcelo CantarovichResearch Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que.
Shaifali SandalResearch Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que. shaifali.sandal@mcgill.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn patients with kidney failure, living donor kidney transplantation (LDKT) is the best treatment option; yet, LDKT rates have stagnated in Canada and vary widely across provinces. We aimed to identify barriers and facilitators to LDKT in a high-performing health system.

methodsThis study was conducted using a qualitative exploratory case study of British Columbia. Data collection, conducted between October 2020 and January 2021, entailed document review and semistructured interviews with key stakeholders, including provincial leadership, care teams and patients. We recruited participants via purposive sampling and snowballing technique. We generated themes using thematic analysis.

resultsAfter analysis of interviews conducted with 22 participants (5 representatives from provincial organizations, 7 health care providers at transplant centres, 8 health care providers from regional units and 2 patients) and document review, we identified the following 5 themes as facilitators to LDKT: a centralized infrastructure, a mandate for timely intervention, an equitable funding model, a commitment to collaboration and cultivating distributed expertise. The relationship between 2 provincial organizations (BC Transplant and BC Renal Agency) was identified as key to enabling the mandate and processes for LDKT. Five barriers were identified that arose from silos between provincial organizations and manifested as inconsistencies in coordinating LDKT along the spectrum of care. These were divided accountability structures, disconnected care processes, missed training opportunities, inequitable access by region and financial burden for donors and recipients.

interpretationWe found strong links between provincial infrastructure and the processes that facilitate or impede timely intervention and referral of patients for LDKT. Our findings have implications for policy-makers and provide opportunities for cross-jurisdictional comparative analyses.

Indexed as

Kidney TransplantationLiving DonorsBritish ColumbiaHumansMedical AssistanceQualitative Research

Identifiers

PMID35440483
PMCPMC9022938

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.