Protocol for the IMPACT Trial: Improving Healthcare Outcomes in American Transplant Recipients Using Culturally-Tailored Novel Technology

Health professional experiences of kidney transplantation in regional, rural, and remote Australia

BACKGROUND

Despite the demonstrated improved patient survival and financial benefits for health services with kidney transplantation compared to dialysis, populations outside of urban areas face inequities in access and a more difficult journey to kidney transplantation than their metropolitan counterparts. This study aimed to explore the experiences of Australian kidney transplant health professionals regarding kidney transplantation processes for patients residing in regional, rural, and remote areas, with a focus on improving access to and experiences of transplantation for this patient cohort.

METHODS

Semi-structured interviews were conducted with Australian kidney transplant health professionals. Transcripts were analysed thematically.

RESULTS

Interview participants (n = 26) consisted primarily of nephrologists from transplanting centres (15%), nephrologists from regional, rural, or remote non-transplanting centres (19%), clinical pharmacists (19%), and nursing staff (19%). Six main themes were identified regarding barriers to transplantation, including ineffective communication and education, overwhelming geographical burden, fighting for equal opportunities, paucity of social support, crushing financial peril, and deprived of adequate local care. Participants also made recommendations for new or modified service delivery models to address identified barriers, including coordination of work-up testing, outreach visits for transplant assessment, increased social and financial support, and increased and earlier provision of transplant education.

CONCLUSIONS

Health professionals described patient-specific and system level barriers to kidney transplantation for regional, rural, and remote populations in Australia that could be addressed or improved by the modification of current processes or implementation of new service delivery models for provision of transplant care.

Lifestyle interventions delivered by eHealth in chronic kidney disease: A scoping review

A method of overcoming barriers associated with implementing lifestyle interventions in CKD may be through the use of eHealth technologies. The aim of this review was to provide an up-to-date overview of the literature on this topic. Four bibliographical databases, two trial registers, and one database for conference proceedings were searched from inception to August 2023. Studies were eligible if they reported a lifestyle intervention using eHealth technologies. A narrative synthesis of the findings from the included studies structured around the type of eHealth intervention was presented. Where a sufficient number of studies overlapped in terms of the type of intervention and outcome measure these were brought together in a direction of effect plot. There were 54 included articles, of which 23 were randomised controlled trials (RCTs). The main component of the intervention for the included studies was mobile applications (n = 23), with the majority being in the dialysis population (n = 22). The majority of eHealth interventions were reported to be feasible and acceptable to participants. However, there was limited evidence that they were efficacious in improving clinical outcomes with the exception of blood pressure, intradialytic weight gain, potassium, and sodium. Although eHealth interventions appear acceptable and feasible to participants, there is insufficient evidence to make recommendations for specific interventions to be implemented into clinical care. Properly powered RCTs which not only demonstrate efficacy, but also address barriers to implementation are needed to enhance widespread adoption.

Multimodal approaches for inequality in kidney care: turning social determinants of health into opportunities

PURPOSE OF REVIEW

Kidney disease is associated with major health and economic burdens worldwide, disproportionately carried by people in low and middle socio-demographic index quintile countries and in underprivileged communities. Social determinants such as education, income and living and working conditions strongly influence kidney health outcomes. This review synthesised recent research into multimodal interventions to promote kidney health equity that focus on the social determinants of health.

RECENT FINDINGS

Inequity in kidney healthcare commonly arises from nationality, race, sex, food insecurity, healthcare access and environmental conditions, and affects kidney health outcomes such as chronic kidney disease progression, dialysis and transplant access, morbidity and mortality. Multimodal approaches to addressing this inequity were identified, targeted to: patients, families and caregivers (nutrition, peer support, financial status, patient education and employment); healthcare teams (workforce, healthcare clinician education); health systems (data coding, technology); communities (community engagement); and health policy (clinical guidelines, policy, environment and research).

SUMMARY

The engagement of diverse patients, families, caregivers and communities in healthcare research and implementation, as well as clinical care delivery, is vital to counteracting the deleterious effects of social determinants of kidney health.