In a study, Medicaid patients were the least likely to have seen a nephrologist before starting RRT.
SAN FRANCISCO—Medicaid patients are less likely to have seen a nephrologist or kidney dietitian prior to starting renal replacement therapy (RRT) compared with patients covered by Medicare or employer group health insurance, data show.
The findings come from an analysis of information gathered on the Medical Evidence form issued by the Centers for Medicare and Medicaid Services. The form asks patients about medical care they received prior to onset of end-stage renal disease (ESRD), including whether patients had seen a nephrologist or renal dietitian before starting RRT. The form also collects information
on patients’ current medical insurance coverage.
Craig Solid, MS, and Allan J. Collins, MD, of the U.S. Renal Data System (USRDS) in Minneapolis, noted in a poster that proper care before patients experience renal failure may improve their prognosis and outcomes once they begin RRT, but few studies have attempted to quantify how many patients are receiving this care prior to ESRD onset.
The investigators, who presented their findings here during Renal Week 2007, used the USRDS database to identify 139,452 unique patients since 2005. Of these, 114,109 patients had complete information on pre-ESRD kidney dietitian care and 124,518 had complete information on pre-ESRD nephrologist care.
Compared with other members of the study population, patients covered by employer group health insurance before development of ESRD were 18% more likely to receive pre-ESRD kidney dietitian care; patients covered by Medicaid prior to ESRD onset were 18% less likely to receive this care. Medicare patients and those covered by employer health insurance were 38% and 61% more likely to have seen a nephrologist prior to ESRD onset compared with other members of the study population; Medicaid patients were 15% less likely to receive this care.
The study found that one third of ESRD patients had not seen a nephrologist before starting RRT, and that only 13% of ESRD patients had received care from a renal dietitian prior to initiating RRT.