- To provide a better understanding of how positive clinical outcomes can be obtained and what components of chronic kidney disease (CKD) management programs influence or enhance acceptability for patients and result in cost-effective care for Aboriginal and Torres Strait Islander people.
- What are the elements of effective CKD programs that attain positive clinical outcomes?
- What components of CKD management programs lead to enhanced Aboriginal and Torres Strait Islander engagement/participation with health services, increased confidence in self-management and demonstrate improved acceptability, including patient satisfaction?
- What are the barriers and enablers to implementation of CKD management programs in Aboriginal and Torres Strait Islander populations?
- What is the evidence of the cost-effectiveness of CKD management programs, in terms of the costs relative to the benefits of the programs/models, from the perspectives of individual patients and their families, the primary health services and tertiary health services?
Chronic kidney disease (CKD) and associated chronic illnesses, including heart disease, stroke and diabetes, constitute half of the gap in life expectancy between Aboriginal and non-Aboriginal Australians. CKD occurs more frequently and in younger age groups among Aboriginal and Torres Strait Islander people, with rates 3 to 5 times the national average in urban areas and up to 30 times the national average in remote areas. Mortality rates are correspondingly high; reports from Queensland, South Australia, Western Australia and the Northern Territory (NT) list CKD as a primary or associated cause of death in 16 percent of Aboriginal and Torres Strait Islander deaths, a rate at least 3.5 times higher than the national average.
The Commonwealth Department of Health has requested a systematic review and evidence synthesis of national and international CKD intervention and management programs.
Implications for policy and practice:
Knowledge acquired from this review may be used to inform the design and implementation of CKD management programs for Aboriginal and Torres Strait Islander populations in Australia.
Our research has found:
There is a lack of high quality evidence in relation to CKD management programs for Indigenous people. However findings suggest that certain program elements are likely to be effective and these include:
- Embedding program management in the primary health service
- Promoting adherence to evidence based protocols
- Nurse-led care in a coordinated care program
- Culturally appropriate patient education
- Intensive patient follow-up.
- Dr Katharine Evans
- Gillian Gorham
July - December 2014
- Australian Government
- South Australian Health and Medical Research Institute (SAHMRI)
- Joanna Briggs Institute (JBI)
- Reilly, R., Evans, K.M., Gomersall, J., Gorham, G., Peters, M., Warren, S., et al. (2016). Effectiveness, cost effectiveness, acceptability and implementation barriers/enablers of chronic kidney disease management programs for Indigenous people in Australia, New Zealand and Canada: a systematic review of mixed evidence. BMC Health Services Research, 16, 119.
- Evans, K.M., Reilly, R., Gomersall, J., Devitt, J., Warren, S., Brown, A., et al. (2015) Managing chronic kidney disease in Indigenous Australians: A systematic review. Report for Commonwealth Department of Health. Menzies School of Health Research. Darwin, Australia.
- Gorham, G., Evans, K.M., Devitt, J., Cass, A. (2015). Managing chronic kidney disease in Indigenous Australians: a narrative synthesis of evidence. Report for Commonwealth Department of Health. Menzies School of Health Research. Darwin, Australia.