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Effect of patient solicitation on mortality among patients receiving hemodialysis in Korea

Authors Lee YK, Choi HY, Kim K, Cho A, Kang WH, Choi YI, Kim DJ

Received 11 March 2019

Accepted for publication 29 May 2019

Published 4 July 2019 Volume 2019:13 Pages 1073—1082

DOI https://doi.org/10.2147/PPA.S208344

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen


Young-Ki Lee,1 Hyung-Yun Choi,2 Kiwon Kim,3 AJin Cho,1 Woo Hun Kang,4 Young Il Choi,5 Dae Joong Kim6

1Department of Internal Medicine, Hallym Kidney Institute, Hallym University College of Medicine, Seoul, Korea; 2Department of Management of Chronic Disease, Korea Centers for Disease Control & Prevention, Cheongju, Chungcheongbuk-do, Korea; 3Department of Internal Medicine, National Cancer Center, Goyang, Gyeonggi-do, Korea; 4Department of Internal Medicine, Samsung Myungin Internal Medicine Clinic, Icheon, Gyeonggi-do, Korea; 5Department of Internal Medicine, Young IL Choi Internal Medicine Clinic, Suwon, Gyeonggi-do, Korea; 6Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Background: There is concern that overcompetition and illegal activities such as patient solicitation by some dialysis units may threaten patients’ health in Korea. Therefore, we investigated the effect of nephrologists’ patient-soliciting activity on hemodialysis practices and patients’ survival using the Korean Health Insurance Review and Assessment Service database.
Methods: We selected 19 soliciting hemodialysis facilities and matched them with 19 non-soliciting facilities located nearby to eliminate location bias. Soliciting behavior was defined as the reduction of medical fees or providing money to attract dialysis patients.
Results: A total of 2,231 incident dialysis patients were included and followed for a median of 37.2 months. Soliciting facilities had a lower percentage of nephrologists, a higher average daily number of hemodialysis patients per physician, and a higher number of hemodialysis patients per nurse compared with non-soliciting facilities. Survival analysis showed that the crude mortality was significantly higher in patients treated in soliciting facilities than in those treated in non-soliciting facilities, even after adjustment for the effects of many other independently predictive covariates.
Conclusions: This study demonstrated that in Korea, the overall mortality rate in incident dialysis patients was higher in those attending soliciting facilities than in those attending non-soliciting facilities.

Keywords: solicitation, hemodialysis, survival


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