Continuity of Care Surrounding Emergency Department Encounters for People with Kidney Failure in Alberta, Canada

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Abstract
Background: People with kidney failure have complex care needs and frequently access care using the emergency department (ED). Little is known about how continuity of care (CoC) relates to ED care seeking for people with kidney failure. To understand the experiences of CoC among adults with kidney failure in relation to their recent ED encounter. Methods: Using a qualitative descriptive methodology, we purposively sampled adults with kidney failure (defined as eGFR <15 mL/min/1.73m2 and/or receipt of maintenance dialysis) from Alberta who accessed the ED for a non-life-threatening indication within the preceding six weeks between May 2024 and January 2025. We conducted individual semi-structured interviews and analyzed transcripts in duplicate using a framework analysis approach with reference to an established framework defining CoC according to 3 types (i.e., relational, management, and informational). Thematic development involved both inductive and deductive techniques. Results: 29 patients were included (12 in-center hemodialysis, 1 in-center nocturnal hemodialysis, 7 peritoneal dialysis, 5 home hemodialysis, and 4 without kidney replacement therapy). Themes were identified within CoC types and across settings of before, during, and after the acute care encounter. Key relational continuity themes included: stability and trust in care teams, disrupted therapeutic relationships, and re-establishing engagement in circles of care. Management continuity themes included: safeguarding kidney supports and kidney care fragmentation in the ED. Informational continuity themes included: patients as continuity self-advocates, bridging care through information sharing, and extending continuity beyond the ED. Conclusions: Patients with kidney failure expressed varied experiences of CoC and identified important gaps relevant to the emergency care context. Strategies that bridge these perceived gaps across outpatient and acute care settings may help to mitigate the burden of ED use in this population.
Funding Information
  • Canadian Institutes of Health Research (178157)
  • Canadian Institutes of Health Research (178157)

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