Same specialty, neighboring markets, potentially different approaches to dialysis access.
The study set out to understand what drives nephrologists to refer patients with end-stage renal disease for a fistula, a graft, or a central venous catheter, and how much influence they have alongside surgeons and interventional radiologists.
The Netherlands and Sweden were chosen deliberately. At the planning stage, the Netherlands was thought to follow a traditional "fistula first" approach, while Sweden was believed to lean toward a newer "patient first" approach. Comparing the two offered a chance to see what each market could learn from the other.
The recruit focused on nephrologists closely involved in access decisions:
At least two years post-residency
At least 75% of time in direct patient care
At least two patients referred each month for access creation
At least two patients referred each month for access revision
The final sample was 20 nephrologists: 12 in the Netherlands and 8 in Sweden. Each took part in an interview of about an hour by Zoom, conducted in English.
The monthly creation and revision thresholds did important work. They screened out nephrologists who rarely deal with access decisions and focused the sample on those who see the full cycle, from first access through to complications and repeat procedures.
That gave the client a grounded comparison of practice, influences and cost considerations in both countries, and a clearer view of where education could help.
