Multidisciplinary providers' perspectives on timely predialysis arteriovenous access preparation: An exploratory mixed-methods study in upper Northern Thailand.

چکیده اصلی

BACKGROUND: Timely creation of arteriovenous (AV) access before hemodialysis initiation is recommended to reduce catheter-related complications and improve clinical outcomes. However, predialysis AV access preparation remains suboptimal in Thailand despite guideline recommendations and expanded hemodialysis services. Evidence comparing perspectives among professional groups involved in the AV access care pathway is limited. This exploratory regional study compared the perspectives of nephrologists, vascular surgeons, and dialysis nurses in Upper Northern Thailand and identified supportive strategies that providers considered relevant to improving timely AV access preparation. METHODS: We conducted a cross-sectional convergent mixed-methods study using a self-administered survey among nephrologists, vascular surgeons, and dialysis nurses practicing in hospitals and dialysis clinics across Upper Northern Thailand from February to April 2025. Likert-scale responses were summarized and compared across professional groups, and brief open-ended responses were analyzed thematically. Quantitative and qualitative findings were integrated during interpretation. RESULTS: A total of 113 providers participated, including 78 nurses, 19 surgeons, and 16 nephrologists. Integration of the quantitative and qualitative findings identified five priority barriers: limited patient understanding, late presentation, procedural waiting times, insurance or reimbursement constraints, and clinical suitability concerns. Although the broad barrier patterns were shared, the emphasis placed on particular barriers varied across professional groups. Four supportive strategies were consistently endorsed: predictable financial coverage and reimbursement mechanisms, a dedicated vascular access coordinator, electronic referral and longitudinal follow-up systems, and proactive, stage-aligned AV access planning guidelines. Qualitative responses provided context by showing that providers associated these shared strategies with different role-related considerations, including patient preparation, referral coordination, procedural feasibility, and timing of care. CONCLUSIONS: Providers in this regional study identified shared priorities for improving timely predialysis AV access preparation, while differing in the meanings and considerations they associated with those priorities. These context-specific, hypothesis-generating findings may inform locally adapted service improvement and future evaluation of the proposed strategies.

ترجمه فارسی چکیده

پیش‌بینی و آماده‌سازی منبع وریدی-عروقی (AV) قبل از شروع دیالیز توصیه می‌شود تا عوارض مرتبط با سوند و نتایج بالینی بهبود یابد. با این حال، آماده‌سازی منبع AV پیش از دیالیز در تایلند همچنان ناکارآمد است. این مطالعه اکتشافی، دیدگاه‌های متخصصان کلیه، جراحان عروقی و پرستاران دیالیز را در شمال‌شرق تایلند مقایسه کرد و استراتژی‌های حمایتی را شناسایی نمود. این مطالعه ترکیبی همبستگی (convergent mixed-methods) با پرسشنامه خودگردان در فوریه تا آوریل ۲۰۲۵ انجام شد. ۱۱۳ ارائه‌دهنده شرکت کردند. موانع پنج‌گانه شناسایی شدند: محدودیت درک بیمار، مراجعه دیرهنگام، زمان انتظار برای پروسیجر، محدودیت‌های بیمه و نگرانی‌های مناسبیت بالینی. چهار استراتژی حمایتی شامل پوشش مالی قابل پیش‌بینی، هماهنگ‌گر منبع وریدی-عروقی، سیستم‌های ارجاع الکترونیکی و ردیابی طولی، و دستورالعمل‌های برنامه‌ریزی منبع AV بودند. یافته‌ها نشان داد که تفاوت‌های معناداری در اولویت‌ها و نگرانی‌ها بین گروه‌های حرفه‌ای وجود دارد.

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