Understanding factors that influence the demand for dialysis among elderly in a multi-ethnic Asian society

Health Policy
Eric A FinkelsteinSheryl Gan Shien Wen

Abstract

Despite literature suggesting conservative management (CM) is a viable option for elderly comorbid ESRD patients, the vast majority in Singapore receive dialysis. We hypothesized that the high demand for dialysis is driven by 1) lack of knowledge of CM and relative benefits of dialysis to CM, 2) adherence to physician recommendations which favour dialysis, and 3) high subsidies for haemodialysis (HD). We tested these hypotheses via a survey, including a discrete choice experiment (DCE), administered to 151 elderly pre-dialysis kidney patients and their family caregivers. Results are consistent with the hypotheses: 40% (95% Confidence Interval (CI) 32-48) of patients and 46% (CI 38-55) of caregivers reported not being aware of CM, and 43% (CI 35-51) of patients and 24% (CI 17-31) of caregivers could not provide information on expected survival for dialysis or CM. Yet, once aware of CM as an option, 54% of patients and 42% of caregivers chose CM. However, if their physician recommended dialysis, 49% (CI 40-58) of patients and 68% (CI 59-77) of caregivers switched their choice. Subsidies on HD further reduced demand for CM by 6 percentage points. These results reveal that the high demand for dialysis is driven mostly by lack of aw...Continue Reading

Citations

Aug 17, 2019·Health Expectations : an International Journal of Public Participation in Health Care and Health Policy·Emeline HanHelena Legido-Quigley
Aug 9, 2020·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Semra OzdemirSu-Yen Goh

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