Effect of Financial Education and Coaching on Economic Stability in Low Income, Single Mother Families.

Kidney failure (., eGFR <15 ml/min per 1.73 m with or without receipt of KRT for at least 3 months) is a complex, chronic condition that is associated with high symptom burden and multiple comorbidities, such as hypertension, diabetes, and cardiovascular disease. As a consequence, people with kidney failure experience a disproportionately high frequency of adverse health outcomes, including mortality, and acute care use compared with the general population and those with earlier stages of CKD. In Canada, people with kidney failure access the emergency department (ED) an average of three times per year for a variety of urgent and emergent health concerns, which is three to eight times more frequently than those without kidney failure. In a universal, publicly funded system where medically necessary primary care, hospital-based (., ED care), and ambulatory specialist (., nephrology care) services are covered for all Canadian residents, the frequent ED use seen in this population can exacerbate ED overcrowding, delays in care, and care fragmentation. Continuity of care (CoC) is a critical component of chronic disease management that has been associated with improved patient outcomes, including reduced ED use, fewer hospitalizations, and lower health care expenditures. The types of CoC include relational continuity, which represents ongoing personal relationships between the service user and the health care professional(s); informational continuity, where information links care from one provider to another and from one health care event to another; and management continuity, where services are delivered in a complementary and timely manner, providing a sense of predictability and security in future care. Compared with the general population, people with kidney failure tend to have lower primary care continuity despite frequent interactions with kidney care teams and other specialists. Limited research among patients with earlier stage CKD demonstrates a stepwise increase in frequency of hospitalization and ED use with decreasing relational continuity of primary care, justifying the need for further study of CoC in the kidney failure context. Several health care integration efforts have sought to improve CoC and, consequently, patient outcomes in a variety of settings. However, such strategies tend to be population-based and not tailored to the unique needs of individuals with kidney failure who often require time-sensitive and specialized interventions, such as dialysis. As people with kidney failure are managed largely by interdisciplinary renal programs, see several specialty care providers, and experience frequent care transitions, understanding their experiences of CoC is essential for addressing high ED use in this population. Therefore, in this study, we sought to explore how adults with kidney failure perceive CoC in relation to their recent ED visit to inform more tailored and person-centered care pathways.