Financial catastrophe and its associated factors among chronic kidney disease patients undergoing haemodialysis in Kathmandu, Nepal: a mixed-method study
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| Publicado en: | BMJ Open vol. 15, no. 12 (2025), p. e109097-e109108 |
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| Acceso en línea: | Citation/Abstract Full Text + Graphics Full Text - PDF |
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| 024 | 7 | |a 10.1136/bmjopen-2025-109097 |2 doi | |
| 035 | |a 3283764707 | ||
| 045 | 2 | |b d20250101 |b d20251231 | |
| 084 | |a 269834 |2 nlm | ||
| 100 | 1 | |a Poudel Swastika |u School of Public Health and Community Medicine , BP Koirala Institute of Health Sciences , Dharan , Nepal | |
| 245 | 1 | |a Financial catastrophe and its associated factors among chronic kidney disease patients undergoing haemodialysis in Kathmandu, Nepal: a mixed-method study | |
| 260 | |b BMJ Publishing Group LTD |c 2025 | ||
| 513 | |a Journal Article | ||
| 520 | 3 | |a ObjectiveThe study aimed to assess the prevalence of financial catastrophe and explore patients’ perceived effectiveness of the government support programme related to chronic kidney disease.DesignCross-sectional mixed-method study.ParticipantsA total of 120 patients receiving free regular haemodialysis under the government’s Deprived Citizen Support Programme for at least 6 months were included in the quantitative study, and 9 patients participated in the qualitative study.Main outcome measuresPrevalence of financial catastrophe and factors associated with financial catastrophe among chronic kidney disease patients undergoing haemodialysis.MethodsA convergent parallel mixed-method approach was carried out from 15 June to 15 December 2024, among chronic kidney disease patients undergoing haemodialysis at the National Kidney Center. Quantitative data were collected through face-to-face interviews using a semi-structured questionnaire. Financial catastrophe was defined as out-of-pocket (OOP) healthcare payments ≥40% of a household’s disposable income, following the WHO-recommended threshold for severe financial burden. OOP expenditures were assessed over 6 months, and associations were tested using χ2 and binary logistic regression at a 95% CI in SPSS V.25.0. For the qualitative arm, in-depth interviews were conducted with nine purposively selected patients, and inductive thematic analysis was applied to explore the perceived effectiveness of the government support programme. The quantitative and qualitative findings were then integrated to achieve convergence and divergence, allowing for a comprehensive understanding of the extent and context of financial hardship among patients.ResultsThe prevalence of financial catastrophe was 72.5%. The factors associated with financial catastrophe were the presence of complications (adjusted OR (AOR): 3.67, 95% CI 1.019 to 13.27), patients without financial support (AOR: 2.77, 95% CI 1.016 to 7.56) and reduction in food expenses (AOR: 0.313, 95% CI 0.109 to 0.896). Qualitative findings on awareness regarding government subsidies, financial strain, barriers to receiving treatment and perceived effectiveness of the programme revealed key aspects of utilisation and effectiveness of the government support programme.ConclusionThe prevalence of financial catastrophe was substantially high, which highlights the importance of addressing economic challenges in chronic kidney disease care. The study emphasised the need to strengthen financial protection through the expansion of government subsidies and improved insurance coverage. | |
| 651 | 4 | |a Nepal | |
| 653 | |a Hemodialysis | ||
| 653 | |a Sample size | ||
| 653 | |a Fatalities | ||
| 653 | |a Sampling techniques | ||
| 653 | |a Cross-sectional studies | ||
| 653 | |a Kidney diseases | ||
| 653 | |a Questionnaires | ||
| 653 | |a Medical research | ||
| 653 | |a Chronic illnesses | ||
| 653 | |a Variables | ||
| 653 | |a Public health | ||
| 653 | |a Audio recordings | ||
| 653 | |a Data collection | ||
| 653 | |a Health care expenditures | ||
| 653 | |a Literature reviews | ||
| 653 | |a Subsidies | ||
| 653 | |a Interviews | ||
| 653 | |a Health disparities | ||
| 653 | |a Clinical trials | ||
| 700 | 1 | |a Yadav, Deepak Kumar |u School of Public Health and Community Medicine , BP Koirala Institute of Health Sciences , Dharan , Nepal | |
| 700 | 1 | |a Khanal, Vijay Kumar |u BP Koirala Institute of Health Sciences , Dharan , Nepal | |
| 700 | 1 | |a Nepal Gurung Gyanu |u School of Public Health and Community Medicine , BP Koirala Institute of Health Sciences , Dharan , Nepal | |
| 700 | 1 | |a Pokhrel Sadiksha |u BP Koirala Institute of Health Sciences , Dharan , Nepal | |
| 700 | 1 | |a Pudasaini Ashok |u Department of Anesthesiology and Critical Care , Shahid Gangalal National Heart Centre , Kathmandu , Nepal | |
| 700 | 1 | |a Amatya, Ashish Govinda |u Department of Anesthesiology and Critical Care , Shahid Gangalal National Heart Centre , Kathmandu , Nepal | |
| 773 | 0 | |t BMJ Open |g vol. 15, no. 12 (2025), p. e109097-e109108 | |
| 786 | 0 | |d ProQuest |t Consumer Health Database | |
| 856 | 4 | 1 | |3 Citation/Abstract |u https://www.proquest.com/docview/3283764707/abstract/embedded/7BTGNMKEMPT1V9Z2?source=fedsrch |
| 856 | 4 | 0 | |3 Full Text + Graphics |u https://www.proquest.com/docview/3283764707/fulltextwithgraphics/embedded/7BTGNMKEMPT1V9Z2?source=fedsrch |
| 856 | 4 | 0 | |3 Full Text - PDF |u https://www.proquest.com/docview/3283764707/fulltextPDF/embedded/7BTGNMKEMPT1V9Z2?source=fedsrch |