Analysis of renal service provision in south and mid Wales.
OBJECTIVE
This paper estimates point prevalence of renal replacement therapy (RRT) utilization within population strata defined by geography and deprivation in south and mid Wales. It investigates spatial accessibility of main and satellite renal units by comparing population and patient numbers within bands of travel time.


METHODS
Prevalence study based on patient registers.


METHODS
From a list of patient and renal unit locations, geocoded at the level of unit postcodes, and electoral division-level denominator population data, we calculated RRT point prevalence for the 16 unitary authorities in the study area, fifths of small area deprivation, and three bands of travel time from the nearest main renal unit and any (main or satellite) unit.


RESULTS
Overall point prevalence was 633 per million population (pmp) and this varied from 256 to 780 pmp across unitary authorities. RRT prevalence was lower in more deprived areas. Sixty-nine percent of the population and 73% of patients lived within 30 min of a main renal unit. Eighty-four percent of the population and 88% of patients lived within 30 min of a main or satellite renal unit.


CONCLUSIONS
The provision of satellite renal units has significantly improved spatial accessibility of RRT services. However, a substantial proportion of the population remains geographically distant from renal units. This has important implications for planning of future provision of RRT, given the inverse relationship between RRT acceptance and travel time, and the impact on quality of life of patients who travel frequently to renal units.
Christie
S
S
National Public Health Service for Wales, Mamhilad Park Estate, Pontypool, Wales NP4 0YP, UK. stephen.christie@nphs.wales.uk
Morgan
G
G
Heaven
M
M
Sandifer
Q
Q
Woerden
H van
Hv
D005843:Geography; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D012042:Registries; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D012923:Social Class; D014852:Wales / Q000453:epidemiology