How Telehealth Can Improve Health Equity and Kidney Transplant Access among African Americans
Historically, African Americans have not had equitable access to kidney transplants. This population has limited representation on kidney transplant waiting lists, and many African American patients remain on waiting lists for many years. They are more likely to be on dialysis for longer once listed on a kidney transplant waiting list. A new study suggests that these disparities in kidney transplant access can be addressed through approaches such as establishing a uniform evaluation process and broadening the use of telehealth services.
According to the authors of the study, which was recently published in the Journal of the American College of Surgeons, the Medical University of South Carolina, located in Charleston, improved African American patients’ access to kidney transplants by using a range of approaches, including simplifying and standardizing the evaluation process, educating patients and staff, increasing the use of telehealth consultations and the judicial use of organs from donors considered high-risk.
According to Dr. Derek DuBay, a transplant surgeon at the Medical University of South Carolina in Charleston and lead author of the study, “interventions to reduce structural barriers in access to transplants significantly increase the proportion of African Americans that can complete a transplant evaluation, be added to the transplant waitlist, and eventually receive a transplant.”
The primary cause of the inequitable access to kidney transplants for African Americans has always been assumed to be due to lower referrals. However, recent kidney transplant data blows this assumption out of the water. In fact, African American kidney patients are more likely to be referred for evaluation than White patients.
One explanation for the higher referral rate of African American patients for kidney transplant is that they tend to experience renal failure sooner and can undergo dialysis for longer than other population groups. As a result, these patients have a greater window of opportunity for referral, said DuBay. Yet while there are more African American referrals, these patients are not getting to transplant centers for evaluation so that they can be put on the kidney transplant waiting list, DuBay explains.
Removing Barriers that Prevent Vulnerable Populations from Being Evaluated for Kidney Transplants
For the study, DuBay and his team analyzed five years of data from patients with end-stage kidney disease. Their goal was to determine what impact intervention measures had on reducing the main barriers that prevented patients from being evaluated once they had been referred for evaluation for a kidney transplant. These interventional measures were developed to reduce the barriers to kidney transplant evaluation without compromising other health and psychological assessments that are needed for an effective evaluation.
Simplifying and Standardizing the Evaluation Process
One of these measures was to streamline the assessment process by introducing more standardized methods of assessment to reduce the variability often encountered between healthcare providers. Many of the tests previously required by some providers, such as chest imaging for former smokers, were eliminated to make it easier for patients.
Educating Patients and Staff
The dialysis center also launched an educational program to increase staff and patients’ knowledge to address some of the common misunderstandings and misconceptions surrounding the kidney transplant process.
Making Use of Telehealth Visits
Another important initiative was the use of virtual telehealth visits to conduct the initial patient evaluation, as well as for some of the follow-up evaluations. This significantly reduced the time required for the in-person evaluation, where key medical tests were conducted. As a result, the patient could get all the required medical tests completed in a day as opposed to two to three days, saving them time and money in travel costs.
Increased Use of Organs Donated by High-Risk Donors
To reduce the wait time for kidney transplants, the medical center used organs from donors considered to be a higher risk, such as those with acute kidney injury, hepatitis C, or those who died from cardiac arrest. Patients were monitored to ensure that the broader use of donors was not having an adverse impact on patient outcomes.
After analyzing patient data of almost 11,500 end-stage kidney disease patients over a five-year period between January 2017 and September 2021, the researchers found that the above interventions significantly reduced racial disparities related to the number of evaluations initiated, evaluations completed, and waiting list inclusion. These interventions provided African Americans with improved access to kidney transplants without negatively impacting outcome.
While the focus of the study did not attempt to determine which intervention was most effective, Dr. DuBay points out that telehealth visits most likely played the biggest role in tearing down the barriers to evaluation, as it reduced the need for patients and their carers to travel to a health center for in-person visits, saving them time and money associated with travel costs.
Telehealth is rapidly being recognized for its role providing vulnerable populations with access to improved health care. For kidney patients, getting evaluated is a crucial step in the kidney transplant process. Telehealth has once again proved to be a useful tool in overcoming barriers that inhibit patients from obtaining the care they need.