PUK6 AN EVALUATION OF THE BRAZILIAN POLICY FOR THE MANAGEMENT OF CHRONIC KIDNEY DISEASE UNDER THE PERSPECTIVE OF THE PUBLIC HEALTH CARE SYSTEM: WAS IT EFFECTIVE?

Abstract

To provide a comprehensive assessment of the Brazilian Chronic Kidney Disease management policy under the perspective of Brazil’s public health care system, identifying difficulties and effects based on other country-specific management policies. It is also hoped to contribute with the Brazilian public health care authorities, physicians and other decision-makers, aiming to improve patient-access to peritoneal dialysis (PD) through peritoneal dialysis-first and/or preferred policies. Data were collected from the Brazilian public health care system database to calculate number of patients on treatment per dialysis modality. The period between March 2013 and February 2014 was taken as baseline, representing the one-year period right before the policy implementation. Subsequent 12-month periods were then compared with the baseline showing the annual progressions. PD modality share was obtained by dividing the number of patients on PD therapy by the total number of patients on renal replacement therapy. A sub analysis was prepared for each of the five Brazilian geographic regions to illustrate possible discrepancies among them. The policy established that PD share should increase to achieve 20% by year 2 after its implementation, but results showed that the policy was not effective: a decrease from 7.0% to 6.0% of the PD share was observed after 4 years in the public system. The decrease in terms of PD share was observed in 4 of the 5 Brazilian geographic regions (more importantly in the North and Northeast). Policy failed in achieving the goal for PD penetration. Necessary measures and incentives were not implemented to support the objectives. Public policies in several countries were effective in overcoming barriers for the expansion of peritoneal dialysis and enhancing the access of their end of stage renal disease patients to treatment. Alternatives tested and well succeeded in other countries could serve as a benchmarking to the Brazilian public health care system.