Accessibility of End-Stage Renal Disease Patients to Health Care Services of a Specialized Hospital

ABSTRACT


INTRODUCTION
Bangladesh has a good public health infrastructure network. The country's health care delivery system consists of three tier network of health care facilities. As a third-tier specialized hospitals, it is equipped with specialized manpower and modern equipment to provide specialized care and treatment of referred cases from the district hospitals and health facilities from the country. There are different types of specialized hospital in the country, National Institute of Kidney Disease and Urology (NIKDU) is one of them. At the specialized level, NIKDU provides special services for the ESRD patients in which person's kidney cease functioning on a permanent basis leading to the need for a regular course of long-term dialysis or kidney transplant to survive life, in terms of access of health services, it is the basic goals around the world but renal complications and many people who have kidney disease lack access to care ˡº ̵ ˡˡ. All of us eventually turn into patients and are forced to look for the medical care we need. Patients often attend the medical practice where they are registered or choose a specific doctor, with the exception of medical crises needing acute care, such as those handled in hospitals ˡ². Now a days, CKD (Chronic kidney disease) is increasing globally, and is projected to become the fifth most common cause of death by 2040 and every ten years, the prevalence of ESRD appears to double ˡ⁵. So, ESRD patients demand timely and suitable health care services in a hospital, as a result, reduce kidney-related complications and death⁷⁻⁸. All ESRD patients are needed diagnostic service, dialysis service and hospital staffs. They also faced different barriers such as physical, financial to get health services by the hospital. In the physical accessibility, these patients are required to go hospital from their different places by using different mode of transport for their treatment. It is evident that accessibility of ESRD patients, tertiary level public health facilities. All these realities especially to the specialized hospital are not up to the mark and they are not well satisfied with the health care services of the ESRD patients⁸. But to meet the health care needs and demand of the ESRD patients their accessibility to specialized hospital must be ensured and accordingly demand based health care services must be provided to those health facilities. Considering theses realities, this specific study was designed to assess accessibility of the ESRD patients to health care services of a specialized hospital. The study findings will contribute to identification of accessibility to health care services of a specialized hospital and accordingly will help to improve the quality and utilization of health care services of the ESRD patients throughout the country.

MATERIALS AND METHODS
Study setting:The study was conducted at National Institute of Kidney Diseases and Urology, Sher-E-Bangla Nagar, Dhaka, Bangladesh during the period from January to December 2021.

Study design:
The study was a Cross-sectional Study to assess the accessibility of End-Stage Renal Disease Patients to Health Care Services of a Specialized Hospital.
Sample size and sampling: The sample size was calculated by using the formula: n=z²pq/d² where n=required sample size; z=1.96 at 95% confidence interval; p= prevalence (50%) 0.5;q=1-p; d is the desired precision or error allowed in the study (set at 0.05).The calculated sample size was 384. Sample was included following purposive sampling technique and using a standard written informed consent form.
Data collection: Data were collected by face-to-face interview with the help of pre-tested semi-structured questionnaire.
Data analysis: Data analysis was done with the help of SPSS software. Descriptive statistics included frequency, percentage, mean, standard deviation while inferential statistics included chi-square test to find association between accessibility and diverse independent variables. Accessibility to health care services was assessed on the basis of findings of fourteen out of thirty seven questions related to accessibility. Each question had two options; "Yes" and "No"; "Yes" answer incurred "1" while and "No" answer incurred "0" score. The total score was ranged from 0 to 14. Finally, accessibility was labeled as; 11-14 was good, 7-10 was average and <7 was poor (Islam,2019).
Ethics: Ethical clearance was obtained from the Institutional Review Board (IRB) of NIPSOM followed by permission was taken from the ethical clearance committee of National Institute of Kidney Diseases and Urology, Sher-E-Bangla Nagar, Dhaka, Bangladesh for data collection. Informed written consent was taken from the each patient informing purpose, procedure, risk and benefits of the study. Privacy of the patient and confidentiality of data were maintained strictly. Corresponding Author: Md. Abdul Jabbar

Socio-demographic characteristics
Males were predominant (67.2%), mean age of the participants was 48.2 (± 12.1) years, around 32.3% had graduation and above of education level, average monthly family income was Tk.44820.31 (±48545.87), and more than one fourth (26%) was housewives. Among the all patients, more than fifty percent of the patients (60%) attained from rural area to assess health care services.

Accessibility of End-Stage Renal Disease Patients to Health Care Services:
Majority of patients correctly demonstrated their responses regarding the questions about accessibility to health care services showed average level of accessibility based on 7-10 out of 14 points. Out of 384 patients (67.7%) got health education on disadvantages of missing of dialysis treatment, 98.4% patients were unaffordable to continue treatment, 66.9% was not satisfied with the location of hospital and only 10.7% patients said dialysis 1 st schedule process by the hospital was easy.    A cross-sectional study on 141 ESRD patients was conducted at the hemodialysis unit of Lahore General Hospital from January to April 2019; using a self-designed questionnaire following informed permission to see how satisfied patients were with hemodialysis as a long-term treatment and how it affected their quality of life and found that more than half of dialysis patients aged 1 to 5 years were dissatisfied in all aspects assessed by patients, with the exception of time spent with the doctor (64.6) and accessibility and convenience (57.0);in addition, there is a link between patient satisfaction measures and personal traits; however, improvements in the financial, communication, and interpersonal aspects of health care should be made in order to improve health care outcomes and, as a result, increase patient satisfaction, and more patient satisfaction research is neededˡ⁴. About half of survey participants (44%) reside within three kilometers of an Upazila Health Complex (UHC), about a third (38%) within five kilometers, and only a small percentage (17%) reside within eight kilometers. UHC only covers an average distance of 3.75 km³. According to research, a sizable portion of the population in Australia's rural and remote areas lacks access to specialized renal disease treatment services within an acceptable driving distance, or 60 minutes⁶⁻ˡ².

CONCLUSION
End-Stage Renal Disease (ESRD) is a significant concern in the present day due to its high treatment cost³. These patients are depended on hospital based treatment for a long period of time⁷. The findings of this study suggest that the location of the hospital was not well located in terms of access .Majority patients were male and age of the patients were within forty six to sixty years. Most of them came to the hospital by bus. The maximum ESRD patients' house was away from hospital. They were needed for long time to access the health services. It suggests that it will be better if this type of service can be decentralized. Among the ESRD patients, majority sold their properties to continue their treatment. Most of the patients were not affordable. This hospital provides dialysis related medicines to the ESRD patients but most of the patients got fewer medicines. It may help the authority to ensure available dialysis related drugs in poor fund and also economically help the poorer. Most of the patients were needed to get admission within last one month during data collection and out of them majority patients didn't get bed for admission due to limited number of bed. In accessibility of dialysis service -third-fourth patients got dialysis schedule by the hospital after a long time. It was found that most of the patients got Jugular/Femoral catheterization access and very fewer got arterio-venous fistula access. According to findings of this study, majority patients got easy access of laboratory test and minority patients got easy access of radiological test. Regarding hospital staffs accessibility, majority patients got constant nursing care. A separate arterio-venous fistula (AVF) unit can be established which may ensure AV-fistula services for whom are needed. This type of hospital can be decentralized for minimizing the duration of ESRD patients arrival time. Planners and policy makers should advice the Government to increase the dialysis bed and dialysis facilities to ensure admission for all patients and reduce the waiting time of dialysis schedule.