title: Regional effects of satellite haemodialysis units on renal replacement therapy in non-urban Ontario, Canada.
abstract: BACKGROUND
  To provide better dialysis care to rural communities, the Ministry of Health chose to build satellite haemodialysis (HD) units, which are affiliated with, but are distant to, a main renal centre. We considered whether constructing such units in rural regions of Ontario, Canada, alleviated under-service of rates of renal replacement therapy (RRT) locally, decreased patient travel distance and decreased local peritoneal dialysis (PD) utilization.
  
  
  METHODS
  We compared two groups of rural regions at two time points (years 1995 and 2002) in a before and after cross-sectional study. These regions were either already serviced by a satellite unit in 1995 (control group, 10 communities), or had new satellite units built between the years 1995 and 2002 (exposure group, 24 communities).
  
  
  RESULTS
  The exposure group had a slightly greater increase in prevalent rate of RRT over time, but this did not reach statistical significance (control group increased 401 per million, exposure group 436 per million, P = 0.8). The mean weekly travel distance was reduced by 210.6 km after the construction of new satellite units (P < 0.001). There was no significant difference between the groups in reduction of PD proportion (P = 0.4). There was a significant increase in the number of elderly receiving RRT once local access was provided.
  
  
  CONCLUSIONS
  In conclusion, constructing satellite units increased access to renal care for elderly patients and reduced travel time for HD patients living in rural communities.
authors.affiliation: Sunnybrook Health Sciences Centre, Canada. suma74@gmail.com
authors.forename: Suma
authors.initials: S
authors.lastname: Prakash
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Oliver
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.forename: Peter G
authors.initials: PG
authors.lastname: Blake
authors.forename: Janet E
authors.initials: JE
authors.lastname: Hux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006781:Hospitals, Satellite; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009864:Ontario; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D017582:Renal Replacement Therapy / Q000379:methods*; D012424:Rural Population