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In Guatemala, there is a prevalence of renal replacement therapy of 564 per million inhabitants, with 45% of the population on continuous ambulatory peritoneal dialysis. The Guatemalan Social Security Institute is responsible for the healthcare of over 1.4 million Guatemalans across the country, covering approximately 34% of the population undergoing renal replacement therapy at the institutional level. Due to the advantages of continuous ambulatory and automated peritoneal dialysis for chronic renal patients, efforts have been made to expand coverage and accessibility by establishing the AMEDIGSS project. This project is centered in Guatemala City with the addition of 7 new peripheral centers in contnry.
The study was designed to comprehensively assess the multifaceted impact of implementing a nationwide network for the decentralization of peritoneal dialysis treatments for renal patients within the Guatemalan social security system. To achieve this, we evaluated four key dimensions. Regarding health promotion, the absence or reduction to an acceptable minimum level of the risk of unnecessary harm during patient transport to professional consultations was quantified using the Google Apps Script platform along with Google Maps. This allowed for precise calculations of distances in kilometers and travel times during average hours, for the avoided travel costs, savings in the basic expenses of patients and their families were estimated by eliminating control and follow-up visits to the central base, taking the standard price of a gallon of gasoline (QTZ 35/gallon) and the fuel consumption of a light vehicle as a reference. Environmental responsibility was evaluated by the reduction in private transportation usage (estimated at 50%) per avoided trip, resulting in fuel savings and reduced CO2 emissions (at a rate of 0.1396 kg CO2/km). Additionally, treatment adherence was measured based on compliance with scheduled appointments.
As of December 2022, a total of 590 patients are receiving peritoneal dialysis (364 on continuous ambulatory and 226 on automated peritoneal dialysis). Of these, 307 patients (52%) are from the departmental area, receiving care at peripheral centers (213 on continuous ambulatory and 84 on automated peritoneal dialysis). A reduction from 20 to 5 trips to the metropolitan area was observed, representing a 75% reduction, with an average reduction of 357.5 km per patient per month and an average reduction of 8.14 hours per patient per month, resulting in a lower risk of unnecessary harm during healthcare. Estimated cost savings amount to QTZ 391.01 per patient per month, with an average cost avoided per patient of QTZ 4,692 per year. Considering the sum of all patients' avoided trips, there is an estimated reduction of 7,386 kg of CO2 emissions per month (88,633 kg CO2 annually, nearly 90 tons of CO2 avoided per year), and patient attendance at scheduled appointments and controls showed a compliance rate exceeding 95% (considering visits to both central and peripheral centers).
The establishment of a decentralized peritoneal dialysis program results in increased patient safety, significant annual cost savings, reduced environmental impact, and improved adherence to medical care.