Evidence map›Paper›PMID 37632667›Full record

ArticleJournal of nephrology2023

The impact on patients of the tertiary-primary healthcare interface in kidney failure: a qualitative study.

Samantha Welke, Emily Duncanson, Chris Bollen, Anne Britton, Fiona Donnelly, Randall Faull, Andrew Kellie, Richard Le Leu, Jo-Anne Manski-Nankervis, Stephen McDonald and 4 more

Abstract read
PubMed Publisher
In one paragraph

Article in Journal of nephrology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
0.4field-weighted citation impact, top 31% of its field
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

0 citing papers in PubMed, 1 citations in OpenAlex.

No citing paper in PubMed yet.

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

14 authors at 3 institutions in 2 countries.

Samantha WelkeCentral Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia. samantha.welke2@sa.gov.au.ORCID http://orcid.org/0000-0001-7332-1081
Emily DuncansonCentral Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia.
Chris BollenCentral Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia.
Anne BrittonCentral Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia.
Fiona DonnellyCentral Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia.
Randall FaullCentral Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia.
Andrew KellieCentral Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia.
Richard Le LeuCentral Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia.
Jo-Anne Manski-NankervisDepartment of General Practice, Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia.
Stephen McDonaldCentral Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia.
Katherine RichardsFaculty of Health and Medical Sciences, University of Otago, Christchurch, New Zealand.
Tiffany WhittingtonCentral Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia.
Jackie YeohCentral Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia.
Shilpanjali JesudasonCentral Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia.
Royal Adelaide Hospital · AUThe University of Melbourne · AUUniversity of Otago · NZ

Funding

Central Adelaide Local Health Network's Chief Executive Officer Clinical Rapid Implementation Project Scheme 12794
6 · The paper itself

Abstract

backgroundClinicians and patients have reported fragmentation in the primary and tertiary healthcare interface. However, perspectives of service navigation and the impacts of fragmentation are not well defined, particularly for patients transitioning to dialysis. This study aimed to define patient perspectives of the functioning of the health service interface and impacts on healthcare experiences and engagement, informing patient-centred and outcomes-focused service models.

methodsA qualitative study was conducted through semi-structured interviews with 25 dialysis patients (16 males) aged 34-78 receiving dialysis across a multi-site tertiary service. Transcripts were analysed thematically.

resultsThree main themes were identified: (1) The Changing Nature of General Practitioner (GP) Patient Relationships; (2) Ownership and Leadership in Kidney Care; and (3) The Importance of Nephrologist-GP Communications. Patients perceived an unreliable primary-tertiary service interface which lacked coordinated care and created challenges for primary care continuity. These impacted perceptions of healthcare provider expertise and confidence in healthcare systems. Patients subsequently increased the healthcare sought from tertiary kidney clinicians. The fractured interface led some to coordinate communication between health sectors, to support care quality, but this caused additional stress.

conclusionsA fragmented primary-tertiary healthcare interface creates challenges for patient service navigation and can negatively impact patient experiences, leading to primary care disengagement, reduced confidence in health care quality and increased stress. Future studies are imperative for assessing initiatives facilitating health system integration, including communication technologies, healthcare provider training, patient empowerment, and specific outcomes in health, economic and patient experience measures, for patients transitioning to dialysis.

Indexed as

Delivery of Health CareRenal InsufficiencyHumansMalePrimary Health CareQualitative ResearchTertiary Health CareChronic kidney diseaseDialysisIntegrated carePrimary careRenal replacement therapy

Identifiers

PMID37632667
OpenAlexW4386192062

What OpenQuestion holds

Textmetadata
Read underepoch 390

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.