spring 2013

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Evidence update

 

Dialysis in rural Newfoundland and Labrador


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The Newfoundland & Labrador Centre for Applied Health Research established the Contextualized Health Research Synthesis Program to provide research evidence to help guide decision makers in the provincial health system on issues of pressing interest to Newfoundland & Labrador.

Submitted Article

The Newfoundland & Labrador Centre for Applied Health Research established the Contextualized Health Research Synthesis Program (CHRSP) to provide research evidence to help guide decision makers in the provincial health system on issues of pressing interest to Newfoundland & Labrador.

In 2008, the CHRSP produced an Evidence in Context Report on rural dialysis that posed the following research question:

“In meeting the needs for dialysis services in rural and remote populations, what are the differences among the available treatment options with regards to efficacy/effectiveness, cost, acceptability, and feasibility in Newfoundland and Labrador?”

The report found no persuasive evidence to suggest that any of the available modalities of dialysis service, including peritoneal dialysis and hemodialysis, is either more or less appropriate for either clinical or economic reasons in rural or remote populations in this province. Both types of dialysis are, in fact, complementary forms of renal replacement therapy, and home-based therapies were recommended as the primary option for rural and remote service provision.

Evidence Update

In late 2012, the Newfoundland and Labrador Centre for Applied Health Research conducted a review to confirm that the findings of the 2008 study remain both current and relevant.

The updated review identified no research indicating that findings presented in the original CHRSP report are inaccurate or out of date.

There is still no persuasive or robust evidence to suggest that either peritoneal dialysis or hemodialysis is inappropriate in the unique rural and remote context of this province.

In the absence of evidence to the contrary, home-based therapies should be considered the primary option for rural and remote service provision, and specific contextual factors should be considered when examining other options.

A preliminary examination into the economic and clinical benefits of the NxStage system may be beneficial.

A copy of the full Evidence Update is available on the NLCAHR Website.

CHRSP does not conduct original research, rather it analyzes the findings of high-level research (systematic reviews, meta-analyses and health technology assessments) that have already been done on the issue in question. The findings of these studies are synthesized and are subjected to a systematic process of ‘contextualization’: they are analyzed in terms of their applicability to the conditions and capacities of the unique context of Newfoundland & Labrador.

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Nexus is published quarterly for Newfoundland and Labrador's physicians. It is a forum for the exchange of views, ideas and information for members.