Access to renal transplantation and post-transplantation prognosis (ReTRAPP) study of adults in Malaysia / Peter Gan Kim Soon
Introduction Renal transplantation (RT) is recognised as the preferred treatment modality for end-stage renal disease. However, Malaysian transplantation rates have been low compared to other countries. Numerous clinical determinants have been associated with renal transplant recipient'...
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Format: | Thesis |
Published: |
2020
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Online Access: | http://studentsrepo.um.edu.my/13280/4/peter.pdf http://studentsrepo.um.edu.my/13280/ |
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Summary: | Introduction
Renal transplantation (RT) is recognised as the preferred treatment modality for
end-stage renal disease. However, Malaysian transplantation rates have been low
compared to other countries. Numerous clinical determinants have been associated with
renal transplant recipient' (RTRs) health, which is the main focus of the healthcare
fraternity. Coincident with the rising interest for equitable healthcare, many studies in the
high-income countries have examined the disparities in RT. On the contrary, little is
known about the association of socioeconomic gradient of RTRs on the access and
outcome of RT in Malaysia, a low- and middle-income country. ReTRAPP was designed
to explore the factors that limit access as well as assess the association of socioeconomic
status (SES) on the access and outcome (survival rate, quality of life and financial burden)
of RT.
Methodology
Collection of qualitative data involved semi-structured interviews with eight key�informants, who are identified by detailed stakeholder analysis. Their responses were
used to explore current RT policy and service availability and to identify relevant themes.
Quantitative data examined from the National Renal Registry of Malaysia for RTRs
above 18 years between 2002 and 2011 (n=1234 recipients).Cox's regression was used to
evaluate the association of SES on access to RT and post-transplantation survival rate.
iv
A quantitative study using a survey was administered to 409 RTRs in 6 public
health facilities in Greater Kuala Lumpur. Linear regression was used to determine the
association of SES on quality of life and logistic regression for association of SES and
catastrophic health expenditure (CHE).
Results
The in-depth interviews are categorised and described by the socio-ecological
model, which provided a framework better to understand the barriers and solutions to RT
in Malaysia. Results from the thematic analysis illustrate a complex interplay of personal,
cultural, and environmental factors. Lower household income was associated with
reduced access to renal transplantation (adjusted PTrend = 0.001). Additionally, patients
with higher educational attainment have a better survival rate post-transplantation
(adjusted PTrend < 0.001). Mean scores for all WHOQOL domains were reduced for RTRs
with low SES compared to high SES. After multivariable adjustment, educational
attainment and household income continued to affect all WHOQOL domains
significantly. 22.7% of RTRs experience CHE due to post-transplantation care.
Household income is the only SES indicator to show statistical significance with Middle
40% household income group and Bottom 40% household income group having 4.7 times
and 5.3 times more risk for CHE.
v
Conclusion
ReTRAPP was conducted to explore the barriers that limit RT and evaluate the
social inequalities in access and outcome of RT. Specific barriers and solutions
highlighted in ReTRAPP indicate a need for policy change in the health service delivery
model to improve the RT rate. ReTRAPP further highlights the disparities in access and
post-transplantation care of RTRs. These findings provide healthcare leaders with
opportunities to reduce disparities through a better understanding of the delivery of care.
Considering the impact of socioeconomic differentials on disparities in healthcare, a
multidiscipline partnership from various stakeholders is necessary to address the
socioeconomic inequality in access to care and health outcomes for RTRs.
Keywords Renal Transplantation, Socio-Economic Status, Access to Renal
Transplantation, Outcome of Renal Transplantation, Malaysia |
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