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Barriers to adopting a fistula-first policy in Europe: an international survey among national experts

(2015) JOURNAL OF VASCULAR ACCESS. 16(2). p.113-119
Author
Organization
Abstract
PURPOSE: The purpose of this study is to explore how vascular access care was reimbursed, promoted, and organised at the national level in European and neighbouring countries. METHODS: An electronic survey among national experts to collect country-level data. RESULTS: Forty-seven experts (response rate, 76%) from 37 countries participated. Experts from 23 countries reported that 50% or less of patients received routine preoperative imaging of vessels. Nephrologists placed catheters and created fistulas in 26 and 8 countries, respectively. Twenty-one countries had a fee per created access; the reported fee for catheter placement was never higher than for fistula creation. As the number of haemodialysis patients in a centre increased, more countries had a dedicated coordinator or multidisciplinary team responsible for vascular access maintenance at the centre-level; in 11 countries, responsibility was always with individual nephrologists, independent of a centre's size. In 23 countries, dialysis centres shared vascular access care resources, with facilitation from a service provider in 4. In most countries, national campaigns (n = 35) or educational programmes (n = 29) had addressed vascular access-related topics; 19 countries had some form of training for creating fistulas. Forty experts considered the current evidence base robust enough to justify a fistula-first policy, but only 13 believed that more than 80% of nephrologists in their country would attempt a fistula in a 75-year-old woman with comorbidities. CONCLUSIONS: Suboptimal access to surgical resources, lack of dedicated training of clinicians, limited routine use of preoperative diagnostic imaging and patient characteristics primarily emerged as potential barriers to adopting a fistula-first policy in Europe.
Keywords
Guideline adherence, Health Services Research, Central venous catheters, Europe, Arteriovenous fistula, DIALYSIS OUTCOMES, PRACTICE PATTERNS, PRACTICE GUIDELINES, Haemodialysis, VASCULAR ACCESS CREATION

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MLA
van der Veer, Sabine N et al. “Barriers to Adopting a Fistula-first Policy in Europe: An International Survey Among National Experts.” JOURNAL OF VASCULAR ACCESS 16.2 (2015): 113–119. Print.
APA
van der Veer, S. N., Ravani, P., Coentrão, L., Fluck, R., Kleophas, W., Labriola, L., Holschen, S. H., et al. (2015). Barriers to adopting a fistula-first policy in Europe: an international survey among national experts. JOURNAL OF VASCULAR ACCESS, 16(2), 113–119.
Chicago author-date
van der Veer, Sabine N, Pietro Ravani, Luis Coentrão, Richard Fluck, Werner Kleophas, Laura Labriola, Susanne H Holschen, Marlies Noordzij, Kitty J Jager, and Wim Van Biesen. 2015. “Barriers to Adopting a Fistula-first Policy in Europe: An International Survey Among National Experts.” Journal of Vascular Access 16 (2): 113–119.
Chicago author-date (all authors)
van der Veer, Sabine N, Pietro Ravani, Luis Coentrão, Richard Fluck, Werner Kleophas, Laura Labriola, Susanne H Holschen, Marlies Noordzij, Kitty J Jager, and Wim Van Biesen. 2015. “Barriers to Adopting a Fistula-first Policy in Europe: An International Survey Among National Experts.” Journal of Vascular Access 16 (2): 113–119.
Vancouver
1.
van der Veer SN, Ravani P, Coentrão L, Fluck R, Kleophas W, Labriola L, et al. Barriers to adopting a fistula-first policy in Europe: an international survey among national experts. JOURNAL OF VASCULAR ACCESS. 2015;16(2):113–9.
IEEE
[1]
S. N. van der Veer et al., “Barriers to adopting a fistula-first policy in Europe: an international survey among national experts,” JOURNAL OF VASCULAR ACCESS, vol. 16, no. 2, pp. 113–119, 2015.
@article{5867557,
  abstract     = {PURPOSE: The purpose of this study is to explore how vascular access care was reimbursed, promoted, and organised at the national level in European and neighbouring countries.
METHODS: An electronic survey among national experts to collect country-level data.
RESULTS: Forty-seven experts (response rate, 76%) from 37 countries participated. Experts from 23 countries reported that 50% or less of patients received routine preoperative imaging of vessels. Nephrologists placed catheters and created fistulas in 26 and 8 countries, respectively. Twenty-one countries had a fee per created access; the reported fee for catheter placement was never higher than for fistula creation. As the number of haemodialysis patients in a centre increased, more countries had a dedicated coordinator or multidisciplinary team responsible for vascular access maintenance at the centre-level; in 11 countries, responsibility was always with individual nephrologists, independent of a centre's size. In 23 countries, dialysis centres shared vascular access care resources, with facilitation from a service provider in 4. In most countries, national campaigns (n = 35) or educational programmes (n = 29) had addressed vascular access-related topics; 19 countries had some form of training for creating fistulas. Forty experts considered the current evidence base robust enough to justify a fistula-first policy, but only 13 believed that more than 80% of nephrologists in their country would attempt a fistula in a 75-year-old woman with comorbidities.
CONCLUSIONS: Suboptimal access to surgical resources, lack of dedicated training of clinicians, limited routine use of preoperative diagnostic imaging and patient characteristics primarily emerged as potential barriers to adopting a fistula-first policy in Europe.},
  author       = {van der Veer, Sabine N and Ravani, Pietro and Coentrão, Luis and Fluck, Richard and Kleophas, Werner and Labriola, Laura and Holschen, Susanne H and Noordzij, Marlies and Jager, Kitty J and Van Biesen, Wim},
  issn         = {1129-7298},
  journal      = {JOURNAL OF VASCULAR ACCESS},
  keywords     = {Guideline adherence,Health Services Research,Central venous catheters,Europe,Arteriovenous fistula,DIALYSIS OUTCOMES,PRACTICE PATTERNS,PRACTICE GUIDELINES,Haemodialysis,VASCULAR ACCESS CREATION},
  language     = {eng},
  number       = {2},
  pages        = {113--119},
  title        = {Barriers to adopting a fistula-first policy in Europe: an international survey among national experts},
  url          = {http://dx.doi.org/10.5301/jva.5000313},
  volume       = {16},
  year         = {2015},
}

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