Subjective parameters markedly limit the referral of transplantation candidates to liver transplant centres

Autor: Gwenaëlle Vidal-Trecan, Olivier Boutet, V. Koné, Christophe Pilette, Philippe Podevin, Catherine Buffet, Claude Eugène, Jacques Doll, Yvon Calmus, Jean-Baptiste Nousbaum, Filomena Conti, Jacques Puyeo
Rok vydání: 2015
Předmět:
Male
medicine.medical_specialty
Time Factors
Referral
Attitude of Health Personnel
medicine.medical_treatment
Liver transplantation
Health Services Accessibility
Medical Records
Organ transplantation
Decision Support Techniques
03 medical and health sciences
Liver disease
0302 clinical medicine
Catchment Area
Health
Liver Cirrhosis
Alcoholic
Predictive Value of Tests
Risk Factors
Surveys and Questionnaires
Odds Ratio
medicine
Humans
030212 general & internal medicine
Healthcare Disparities
Practice Patterns
Physicians'
Referral and Consultation
Aged
Physician-Patient Relations
Hepatology
business.industry
Medical record
Process Assessment
Health Care
Age Factors
Odds ratio
Middle Aged
medicine.disease
Liver Transplantation
Surgery
Transplantation
Logistic Models
Multivariate Analysis
Cohort
Emergency medicine
Patient Compliance
Female
030211 gastroenterology & hepatology
France
Empathy
business
Zdroj: Liver International. 36:555-562
ISSN: 1478-3223
Popis: BACKGROUND & AIMS Equality of access to organ transplantation is a mandatory public health requirement. Referral from a local to a university hospital and then registration on the national waiting list are the two key steps enabling access to liver transplantation (LT). Although the latter procedure is well defined using the Model for End-stage Liver Disease score that improves equality of access, the former is mostly reliant on the practices of referring physicians. The aim of this study was to clarify the factors determining this initial step. METHODS This observational study included consecutive inpatients with cirrhosis of whatever origin in a cohort constituted between 2003 and 2008, using medical records and structured questionnaires concerning patient characteristics and the opinions of hospital clinicians. Candidates for LT were defined in line with these opinions. RESULTS Four hundred and thirty-three patients, mostly affected by alcoholic cirrhosis, were included, 21.0% of whom were considered to be candidates for LT. Factors independently associated with their candidature were: physician empathy [odds ratio (OR) = 10.8; 95% CI: 4.0-29.5], adherence to treatment (OR = 16.6; 95% CI: 3.7-75.2), geographical area (OR = 6.8; 95% CI: 2.2-21.3) and the patient's physiological age (OR = 2.3; 95% CI: 1.1-4.7). CONCLUSIONS Several subjective markers restrict the referral of patients from local hospitals to liver transplant centres. Their advancement to this second step is thus markedly weakened by initial subjectivity. The development of objective guidelines for local hospital physicians to assist them with their initial decision-making on LT is now necessary.
Databáze: OpenAIRE
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