Virtual Care Utilization and Peritonitis Risk in Rural and Indigenous Peritoneal Dialysis Patients.

Area of Science:

• Nephrology
• Public Health
• Health Services Research

Background:

• Peritoneal dialysis (PD) is a vital home-based therapy for kidney failure, particularly for remote populations.
• Trust, continuity, and technical skill are paramount for safe PD care.
• The COVID-19 pandemic increased virtual care use and PD-associated peritonitis.

Purpose of the Study:

• To investigate the association between virtual care, patient demographics, and peritonitis risk in PD.
• To explore patient perceptions of care quality and continuity in a virtual care context.

Main Methods:

• Retrospective cohort study (2021-2023) with qualitative interviews.
• Data extracted from provincial databases and patient charts.
• Root Cause Analysis (RCA) for peritonitis episodes; multivariable logistic regression and semi-structured interviews.

Main Results:

• Peritonitis episodes were significantly higher in patients from rural Indigenous communities (70.5% of episodes).
• Peritonitis risk associated with Indigenous community residence (OR: 2.45), high virtual care exposure (OR: 2.85), and technique failure (OR: 3.12).
• Qualitative data revealed diminished trust, inadequate training, and perceived clinical detachment.

Conclusions:

• High virtual care exposure correlates with increased peritonitis risk, especially in rural Indigenous PD patients.
• Adapting PD care models to enhance trust, hands-on training, and cultural safety is recommended.
• Future strategies should focus on culturally sensitive, in-person support to mitigate peritonitis risks.