S KOTWAL1,2, N BOUDVILLE3, P SNELLING4, S MCDONALD5, B COOPER6, A CASS7, M GALLAGHER2,8
1Prince Of Wales Hospital, Sydney, Australia, 2The George Institute for Global Health, Sydney, Australia, 3Sir Charles Gairdner Hospital, Perth, Australia, 4Royal Prince Alfred Hospital, Sydney, Australia, 5ANZDATA Registry, Adelaide, Australia, 6Royal North Shore Hospital, Sydney, Australia, 7Menzies School of Health Research, Darwin, Australia, 8Concord Clinical School, University of Sydney, Sydney, Australia
Aim: Understand patterns of outpatient health service use around dialysis initiation.
Background: Data on outpatient health service use in the lead up to renal replacement therapy (RRT) initiation, such as physician review, and out of pocket (OOP) costs for patients, has been unavailable in Australia.
Methods: Consent was sought for all incident patients commencing dialysis at Concord Repatriation General, Royal Prince Alfred, Royal North Shore and Sir Charles Gairdner Hospitals between 01/01/2011 and 30/06/2012 for data linkage to the ANZDATA registry, the Medicare and Pharmaceutical Benefits Scheme (MBS and PBS) datasets. We calculated the median number of physician visits, total OOP expenses from MBS and PBS use (outpatient medical consults, radiology, pathology) in the 12-months prior to, and the 12-months following, RRT commencement.
Results: Out of a total of 197 eligible patients 97 died before consent could be obtained for MBS & PBS linkage. Of the 100 patients with linkage, 6 did not match with ANZDATA, leaving 94 in the analytical dataset. Median age was 59 years with 75% (n=70) male. A total of 73 patients had an outpatient physician consult in the 24 months around dialysis initiation, with a median of 4 (IQR 1-8) visits in the year prior to starting dialysis, and a median of 6 (IQR 3-9) visits in the year after starting dialysis. Median total OOP expenses were $293 (IQR $20-$1178) in the 12 months prior to starting dialysis and $339 (IQR $23-$1579) in the 12 months after.
Conclusions: Linkage of patients receiving maintenance RRT to Australian Government datasets is feasible and acceptable to most patients. Such data promises novel insights into medication and health service usage and should be pursued.
Dr Kotwal is a nephrologist at Prince of Wales Hospital in Sydney Australia and a post-doctoral research fellow at the George Institute of Global Health. Her main area of interests lie in the use of linked health data and evidence implementation research.
She has a background in epidemiology, biostatistics and the analysis of linked health data. She has designed and led multiple data linkage projects across Australia and has experience in analysis of large observational registry and administrative datasets.