Multidisciplinary providers’ perspectives on timely predialysis arteriovenous access preparation: An exploratory mixed-methods study in upper Northern Thailand
8 affiliations
- 1Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- 2School of Health Sciences Research, Research Institute for Health Sciences (RIHES), Chiang Mai University, Chiang Mai, Thailand
- 3Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- 4Department of Internal Medicine, Nakornping Hospital, Chiang Mai, Thailand
- 5Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
- 6Department of Surgery, Faculty of Medicine, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand
- 7Environmental and Occupational Health Sciences and Non-Communicable Diseases Research Center, Chiang Mai University, Chiang Mai, Thailand
- 8Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Abstract
Background: Timely creation of arteriovenous (AV) access before hemodialysis initiation is recommended to reduce catheter-related complications and improve clinical outcomes. However, predialysis AV access preparation remains suboptimal in Thailand despite guideline recommendations and expanded hemodialysis services. Evidence comparing perspectives among professional groups involved in the AV access care pathway is limited. This exploratory regional study compared the perspectives of nephrologists, vascular surgeons, and dialysis nurses in Upper Northern Thailand and identified supportive strategies that providers considered relevant to improving timely AV access preparation. Methods: We conducted a cross-sectional convergent mixed-methods study using a self-administered survey among nephrologists, vascular surgeons, and dialysis nurses practicing in hospitals and dialysis clinics across Upper Northern Thailand from February to April 2025. Likert-scale responses were summarized and compared across professional groups, and brief open-ended responses were analyzed thematically. Quantitative and qualitative findings were integrated during interpretation. Results: A total of 113 providers participated, including 78 nurses, 19 surgeons, and 16 nephrologists. Integration of the quantitative and qualitative findings identified five priority barriers: limited patient understanding, late presentation, procedural waiting times, insurance or reimbursement constraints, and clinical suitability concerns. Although the broad barrier patterns were shared, the emphasis placed on particular barriers varied across professional groups. Four supportive strategies were consistently endorsed: predictable financial coverage and reimbursement mechanisms, a dedicated vascular access coordinator, electronic referral and longitudinal follow-up systems, and proactive, stage-aligned AV access planning guidelines. Qualitative responses provided context by showing that providers associated these shared strategies with different role-related considerations, including patient preparation, referral coordination, procedural feasibility, and timing of care. Conclusions: Providers in this regional study identified shared priorities for improving timely predialysis AV access preparation, while differing in the meanings and considerations they associated with those priorities. These context-specific, hypothesis-generating findings may inform locally adapted service improvement and future evaluation of the proposed strategies.
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BibTeX
@article{rerkasem2026multidisciplinary,
title = {{Multidisciplinary providers’ perspectives on timely predialysis arteriovenous access preparation: An exploratory mixed-methods study in upper Northern Thailand}},
author = {Amaraporn Rerkasem and Kochaphan Phirom and Pak Thaichana and Prit Kusirisin and Puntapong Taruangsri and Suwinai Saengyo and Sasinat Pongtam and Wanicha Pungchompoo and Kittipan Rerkasem},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0359863},
url = {https://doi.org/10.1371/journal.pone.0359863},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Multidisciplinary providers’ perspectives on timely predialysis arteriovenous access preparation: An exploratory mixed-methods study in upper Northern Thailand
AU - Amaraporn Rerkasem
AU - Kochaphan Phirom
AU - Pak Thaichana
AU - Prit Kusirisin
AU - Puntapong Taruangsri
AU - Suwinai Saengyo
AU - Sasinat Pongtam
AU - Wanicha Pungchompoo
AU - Kittipan Rerkasem
PY - 2026
DA - 2026/10/05
JO - PLOS One
DO - 10.1371/journal.pone.0359863
UR - https://doi.org/10.1371/journal.pone.0359863
AB - Background: Timely creation of arteriovenous (AV) access before hemodialysis initiation is recommended to reduce catheter-related complications and improve clinical outcomes. However, predialysis AV access preparation remains suboptimal in Thailand despite guideline recommendations and expanded hemodialysis services. Evidence comparing perspectives among professional groups involved in the AV access care pathway is limited. This exploratory regional study compared the perspectives of nephrologists, vascular surgeons, and dialysis nurses in Upper Northern Thailand and identified supportive strategies that providers considered relevant to improving timely AV access preparation. Methods: We conducted a cross-sectional convergent mixed-methods study using a self-administered survey among nephrologists, vascular surgeons, and dialysis nurses practicing in hospitals and dialysis clinics across Upper Northern Thailand from February to April 2025. Likert-scale responses were summarized and compared across professional groups, and brief open-ended responses were analyzed thematically. Quantitative and qualitative findings were integrated during interpretation. Results: A total of 113 providers participated, including 78 nurses, 19 surgeons, and 16 nephrologists. Integration of the quantitative and qualitative findings identified five priority barriers: limited patient understanding, late presentation, procedural waiting times, insurance or reimbursement constraints, and clinical suitability concerns. Although the broad barrier patterns were shared, the emphasis placed on particular barriers varied across professional groups. Four supportive strategies were consistently endorsed: predictable financial coverage and reimbursement mechanisms, a dedicated vascular access coordinator, electronic referral and longitudinal follow-up systems, and proactive, stage-aligned AV access planning guidelines. Qualitative responses provided context by showing that providers associated these shared strategies with different role-related considerations, including patient preparation, referral coordination, procedural feasibility, and timing of care. Conclusions: Providers in this regional study identified shared priorities for improving timely predialysis AV access preparation, while differing in the meanings and considerations they associated with those priorities. These context-specific, hypothesis-generating findings may inform locally adapted service improvement and future evaluation of the proposed strategies.
SN - 1932-6203
ER -