Dr Gillian Gorham earned her PhD from Charles Darwin University in 2021, for her thesis exploring the concept of ‘place’ in the delivery of dialysis services in the Northern Territory (NT).
Most dialysis patients in the NT are Aboriginal and live in remote areas. However, most dialysis services are centralised in urban areas, requiring large numbers of Aboriginal patients to relocate to receive treatment. Significant costs are incurred in the process of relocating dialysis patients, including psychological costs and downstream health care costs.
Dr Gorham’s analysis compared the uptake of dialysis treatments and subsequent downstream impacts according to where patients receive dialysis care, being either urban, rural, or remote parts of the NT.
Patients, their families and communities have argued that being able to receive dialysis at home or closer to home, is more likely to improve health compared to having to relocate for treatment. Closer access to family and community support is associated with better dialysis attendance leading to fewer health complications and hospitalisations.
The mixed methods study examines health care activity (dialysis treatment and hospitalisations associated with where people receive treatment), total health care costs and patients’ views of the different dialysis models in different locations.
Remote staffed facilities are more expensive than those in an urban setting, but financial models based on upfront dialysis treatment alone, fail to consider the significant downstream (hospitalisation) costs associated with these facilities. Dr Gorham’s analysis found the incremental cost differences associated with different models of care in different settings are significantly reduced when all health service costs are included.
A key component of the study was to explore different views from patients, clinicians and policy makers regarding the costs and benefits of the different dialysis models of care. A Value for Money framework, developed in a participatory co-design process with these stakeholders, identified six criteria spanning biomedical outcomes, costs of health service delivery, and patient views of what made for a good life on dialysis. Dr Gorham said that integral to these challenges was developing a shared understanding, from multiple stakeholder perspectives, regarding what they saw as important, and ensuring Aboriginal participants were genuinely engaged in the codesign process from the beginning.
“This process delivers a shared understanding and appreciation of what all stakeholders see as important features of a model of care and has implications for how policy decisions are determined in the future,” Dr Gorham said.
This month, Dr Gorham's PhD was recognised by the Health Services Research Association of Australia and New Zealand HSRAANZ, being awarded the Professor Margaret Kelaher Best PhD Paper Award for her thesis.