Abstract
Background: Kidney failure is associated with significant financial burden. It is often one of the main determining factors for patients with end-stage renal disease (ESRD) when considering dialysis.Frequently, patients may delay dialysis treatment as a result of limited finance. They end up with high Emergency Department (ED) attendances and hospitalization as a result of their symptoms associated with poorly controlled renal disease. By supporting the financial burden of dialysis for these ESRD patients, they get timely access to dialysis and optimal disease control.
Approach: Medical Social Workers (MSWs) worked closely with Integrated Medical Clinic (IMC) team to co-design the care model for renal patients with complex needs. Teams were involved in shared care discussion with community partners.Medical Social Workers (MSWs) will apply for interim financial assistance accorded by the hospital, to support eligible patients. This increases patients propensity for treatment, despite their dire financial circumstances.To ensure sustainability of their lifelong costly treatment, MSWs will apply for additional financial assistance from Voluntary Welfare Organization (VWO) which will offer subsidised dialysis treatments and access to care team of professionals (consisting of Nurses, Dietician, Therapist, Social Workers) in the community.Care teams in the hospital and community will be linked up by MSWs to ensure proper handovers and improved communication. This collaboration allows for more comprehensive understanding of the patients circumstances, better alignment of expectations and improved coordination of management. This ultimately fosters a much-trusted relationship between the various care teams. Integrated Medical Clinic (IMC) was set up to provide greater support for selected patients with medically advanced and chronic conditions as well as complex psycho-social needs. In IMC, the Primary Coordinating Doctor (PCD) leads a team consisting of MSWs, psychologists, coordinator, and community partners. This provides a stronger holistic care by promoting better care ownership and encouraging patient empowerment.The objective of this study is to demonstrate the positive impact of integrated care in Khoo Teck Puat Hospital (KTPH) through the analysis of ED visit rates and the length of stay of patients admissions, before and after initiating dialysis.
Results: A study on the ED visits and admissions of 35 patients who received financial assistance for their subsidized dialysis treatment was conducted. Among this group of patients, 65% of them do not have increase in their ED visits post dialysis initiation. Instead, there was a reduction of .7 ED visits observed.Additionally, there is reduction of 8 days in the average length of stay (LOS) pre-post integrated care and support for the 35 patients who had received financial assistance for their subsidized dialysis treatment between January to June 2023. 77% of the patients had a reduction in their LOS.Despite the complexity of patients medical condition and social circumstances, 6 out of the 9 patients under IMC had a 47% reduction in ED visits and 67% reduction in LOS (average 2.4 days LOS reduction).
ImplicationsThe integrated care and availability of enhanced support from hospital care team and collaboration with the community partners improved the general well-being of renal patients. IMC aims to continue strengthening the collaboration with community partners to provide greater access to comprehensive care.