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Arnold-Ujvari M, Rix E, Kelly J. The emergence of cultural safety within kidney care for Indigenous Peoples in Australia. Nurs Inq 2024:e12626. [PMID: 38476033 DOI: 10.1111/nin.12626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 03/14/2024]
Abstract
Cultural safety is increasingly recognised as imperative to delivering accessible and acceptable healthcare for First Nations Peoples within Australia and in similar colonised countries. A literature review undertaken to inform the inaugural Caring for Australians with Renal Insufficiency (CARI) guidelines for clinically and culturally safe kidney care for Aboriginal and Torres Strait Islander peoples revealed a timeline of the emergence of culturally safe kidney care in Australia. Thirty years ago, kidney care literature was purely biomedically focused, with culture, family and community viewed as potential barriers to patient 'compliance' with treatment. The importance of culturally informed care was increasingly recognised in the mid-1990s, with cultural safety within kidney care specifically cited from 2014 onwards. The emergence timeline is discussed in this paper in relation to the five principles of cultural safety developed by Māori nurse Irihapeti Ramsden in Aotearoa/New Zealand. These principles are critical reflection, communication, minimising power differences, decolonisation and ensuring one does not demean or disempower. For the kidney care workforce, culturally safe care requires ongoing critical reflection, deep active listening skills, decolonising approaches and the eradication of institutional racism. Cultural safety is the key to truly working in partnership, increasing Indigenous Governance, respectful collaboration and redesigning kidney care.
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Affiliation(s)
- Melissa Arnold-Ujvari
- Adelaide Nursing School, North Terrace, University of Adelaide, Adelaide, South Australia, Australia
| | - Elizabeth Rix
- Adelaide Nursing School, North Terrace, University of Adelaide, Adelaide, South Australia, Australia
| | - Janet Kelly
- Adelaide Nursing School, North Terrace, University of Adelaide, Adelaide, South Australia, Australia
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Coombes J, Holland AJA, Ryder C, Finlay SM, Hunter K, Bennett-Brook K, Orcher P, Scarcella M, Briscoe K, Forbes D, Jacques M, Maze D, Porykali B, Bourke E, Kairuz Santos CA. Discharge interventions for First Nations people with a chronic condition or injury: a systematic review. BMC Health Serv Res 2023; 23:604. [PMID: 37296401 DOI: 10.1186/s12913-023-09567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander peoples have a unique place in Australia as the original inhabitants of the land. Similar to other First Nations people globally, they experience a disproportionate burden of injury and chronic health conditions. Discharge planning ensures ongoing care to avoid complications and achieve better health outcomes. Analysing discharge interventions that have been implemented and evaluated globally for First Nations people with an injury or chronic conditions can inform the implementation of strategies to ensure optimal ongoing care for Aboriginal and Torres Strait Islander people. METHODS A systematic review was conducted to analyse discharge interventions conducted globally among First Nations people who sustained an injury or suffered from a chronic condition. We included documents published in English between January 2010 and July 2022. We followed the reporting guidelines and criteria set in Preferred Reporting Items for Systematic Review (PRISMA). Two independent reviewers screened the articles and extracted data from eligible papers. A quality appraisal of the studies was conducted using the Mixed Methods Appraisal Tool and the CONSIDER statement. RESULTS Four quantitative and one qualitative study out of 4504 records met inclusion criteria. Three studies used interventions involving trained health professionals coordinating follow-up appointments, linkage with community care services and patient training. One study used 48-hour post discharge telephone follow-up and the other text messages with prompts to attend check-ups. The studies that included health professional coordination of follow-up, linkage with community care and patient education resulted in decreased readmissions, emergency presentations, hospital length of stay and unattended appointments. CONCLUSION Further research on the field is needed to inform the design and delivery of effective programs to ensure quality health aftercare for First Nations people. We observed that discharge interventions in line with the principal domains of First Nations models of care including First Nations health workforce, accessible health services, holistic care, and self-determination were associated with better health outcomes. REGISTRATION This study was prospectively registered in PROSPERO (ID CRD42021254718).
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Affiliation(s)
- Julieann Coombes
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Andrew J A Holland
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Corner Hawkesbury Road and, Hainsworth St, Westmead, NSW, 2145, Australia
| | - Courtney Ryder
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
- Indigenous Health College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - Summer May Finlay
- School of Health and Society, Wollongong University, Wollongong, NSW, 2522, Australia
| | - Kate Hunter
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Keziah Bennett-Brook
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Phillip Orcher
- Agency for Clinical Innovations, 1 Reserve Rd, St Leonards, NSW, 2065, Australia
| | - Michele Scarcella
- The Sydney Children's Hospital Network (SCHN), Sydney, NSW, 2145, Australia
| | - Karl Briscoe
- National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP), 31-37 Townshend Street, Phillip ACT, 2606, Australia
| | - Dale Forbes
- Department Community and Justice NSW, Sydney, NSW, 2012, Australia
| | - Madeleine Jacques
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Corner Hawkesbury Road and, Hainsworth St, Westmead, NSW, 2145, Australia
| | - Deborah Maze
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Corner Hawkesbury Road and, Hainsworth St, Westmead, NSW, 2145, Australia
| | - Bobby Porykali
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Elizabeth Bourke
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Camila A Kairuz Santos
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia.
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Abstract
Haemodialysis (HD) is the commonest form of kidney replacement therapy in the world, accounting for approximately 69% of all kidney replacement therapy and 89% of all dialysis. Over the last six decades since the inception of HD, dialysis technology and patient access to the therapy have advanced considerably, particularly in high-income countries. However, HD availability, accessibility, cost and outcomes vary widely across the world and, overall, the rates of impaired quality of life, morbidity and mortality are high. Cardiovascular disease affects more than two-thirds of people receiving HD, is the major cause of morbidity and accounts for almost 50% of mortality. In addition, patients on HD have high symptom loads and are often under considerable financial strain. Despite the many advances in HD technology and delivery systems that have been achieved since the treatment was first developed, poor outcomes among patients receiving HD remain a major public health concern. Understanding the epidemiology of HD outcomes, why they might vary across different populations and how they might be improved is therefore crucial, although this goal is hampered by the considerable heterogeneity in the monitoring and reporting of these outcomes across settings. This Review examines the epidemiology of haemodialysis outcomes — clinical, patient-reported and surrogate outcomes — across world regions and populations, including vulnerable individuals. The authors also discuss the current status of monitoring and reporting of haemodialysis outcomes and potential strategies for improvement. Nearly 4 million people in the world are living on kidney replacement therapy (KRT), and haemodialysis (HD) remains the commonest form of KRT, accounting for approximately 69% of all KRT and 89% of all dialysis. Dialysis technology and patient access to KRT have advanced substantially since the 1960s, particularly in high-income countries. However, HD availability, accessibility, cost and outcomes continue to vary widely across countries, particularly among disadvantaged populations (including Indigenous peoples, women and people at the extremes of age). Cardiovascular disease affects over two-thirds of people receiving HD, is the major cause of morbidity and accounts for almost 50% of mortality; mortality among patients on HD is significantly higher than that of their counterparts in the general population, and treated kidney failure has a higher mortality than many types of cancer. Patients on HD also experience high burdens of symptoms, poor quality of life and financial difficulties. Careful monitoring of the outcomes of patients on HD is essential to develop effective strategies for risk reduction. Outcome measures are highly variable across regions, countries, centres and segments of the population. Establishing kidney registries that collect a variety of clinical and patient-reported outcomes using harmonized definitions is therefore crucial. Evaluation of HD outcomes should include the impact on family and friends, and personal finances, and should examine inequities in disadvantaged populations, who comprise a large proportion of the HD population.
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Huria T, Pitama SG, Beckert L, Hughes J, Monk N, Lacey C, Palmer SC. Reported sources of health inequities in Indigenous Peoples with chronic kidney disease: a systematic review of quantitative studies. BMC Public Health 2021; 21:1447. [PMID: 34301234 PMCID: PMC8299576 DOI: 10.1186/s12889-021-11180-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To summarise the evidentiary basis related to causes of inequities in chronic kidney disease among Indigenous Peoples. METHODS We conducted a Kaupapa Māori meta-synthesis evaluating the epidemiology of chronic kidney diseases in Indigenous Peoples. Systematic searching of MEDLINE, Google Scholar, OVID Nursing, CENTRAL and Embase was conducted to 31 December 2019. Eligible studies were quantitative analyses (case series, case-control, cross-sectional or cohort study) including the following Indigenous Peoples: Māori, Aboriginal and Torres Strait Islander, Métis, First Nations Peoples of Canada, First Nations Peoples of the United States of America, Native Hawaiian and Indigenous Peoples of Taiwan. In the first cycle of coding, a descriptive synthesis of the study research aims, methods and outcomes was used to categorise findings inductively based on similarity in meaning using the David R Williams framework headings and subheadings. In the second cycle of analysis, the numbers of studies contributing to each category were summarised by frequency analysis. Completeness of reporting related to health research involving Indigenous Peoples was evaluated using the CONSIDER checklist. RESULTS Four thousand three hundred seventy-two unique study reports were screened and 180 studies proved eligible. The key finding was that epidemiological investigators most frequently reported biological processes of chronic kidney disease, particularly type 2 diabetes and cardiovascular disease as the principal causes of inequities in the burden of chronic kidney disease for colonised Indigenous Peoples. Social and basic causes of unequal health including the influences of economic, political and legal structures on chronic kidney disease burden were infrequently reported or absent in existing literature. CONCLUSIONS In this systematic review with meta-synthesis, a Kaupapa Māori methodology and the David R Williams framework was used to evaluate reported causes of health differences in chronic kidney disease in Indigenous Peoples. Current epidemiological practice is focussed on biological processes and surface causes of inequity, with limited reporting of the basic and social causes of disparities such as racism, economic and political/legal structures and socioeconomic status as sources of inequities.
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Affiliation(s)
- Tania Huria
- Māori Indigenous Health Institute, University of Otago Christchurch, 2 Riccarton Ave, Christchurch, 8140, New Zealand.
| | - Suzanne G Pitama
- Māori Indigenous Health Institute, University of Otago Christchurch, 2 Riccarton Ave, Christchurch, 8140, New Zealand
| | - Lutz Beckert
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | | | - Nathan Monk
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Cameron Lacey
- Māori Indigenous Health Institute, University of Otago Christchurch, 2 Riccarton Ave, Christchurch, 8140, New Zealand
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
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Secombe P, Moynihan G, McAnulty G. Long-term outcomes of dialysis-dependent chronic kidney disease patients requiring critical care: an observational matched cohort study. Intern Med J 2021; 51:548-556. [PMID: 31990145 DOI: 10.1111/imj.14764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/25/2019] [Accepted: 01/12/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The prevalence of dialysis-dependent chronic kidney disease (CKD5D) patients in Australia is increasing. AIMS To describe the long-term outcome and resource utilisation of CKD5D patients requiring critical care admission. METHODS Retrospective matched cohort study conducted in the intensive care unit (ICU) of Alice Springs Hospital. CKD5D patients admitted between 1 January 2011 and 31 December 2013 were matched by sex, age, Indigenous status and APACHE III score in a 1:1 ratio with a patient without CKD5D. Primary outcome was mortality censored at 31 December 2018, to allow a minimum 5-year follow up. Secondary outcomes explored resource use including ICU and hospital length of stay (LoS). RESULTS During the study period, 178 (9%) admissions were coded as having CKD5D, 148 (83%) of which were successfully matched. CKD5D patients were older (52 vs 49 years, P < 0.01), with more chronic cardiovascular disease (34 vs 23%, P < 0.01). Five-year mortality was similar (49.5 vs 41.5%, P = 0.28), with a significantly longer time to death in the CKD5D cohort (1179 vs 341 days, P < 0.01). CKD5D patients had a shorter median ICU LoS (1.9 vs 3.0 days, P < 0.01) and lower rates of mechanical ventilation (12.2 vs 35.4%, P < 0.01). CONCLUSION CKD5D patients frequently require intensive care during acute illness. While they have an equivalent 5-year survival rate, time to death is longer suggesting mortality is related to chronic disease progression rather than their acute illness. These results suggest the presence of CKD5D in isolation should not be a reason to limit critical care.
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Affiliation(s)
- Paul Secombe
- Department of Intensive Care, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.,School of Medicine, Flinders University, Adelaide, South Australia, Australia.,School of Epidemiology and Public Health, Monash University, Melbourne, Victoria, Australia
| | - Gerard Moynihan
- Department of Intensive Care, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Greg McAnulty
- Department of Intensive Care, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
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Marshall MR, Polkinghorne KR, Boudville N, McDonald SP. Home Versus Facility Dialysis and Mortality in Australia and New Zealand. Am J Kidney Dis 2021; 78:826-836.e1. [PMID: 33992726 DOI: 10.1053/j.ajkd.2021.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 03/03/2021] [Indexed: 12/23/2022]
Abstract
RATIONALE & OBJECTIVE Mortality is an important outcome for all dialysis stakeholders. We examined associations between dialysis modality and mortality in the modern era. STUDY DESIGN Observational study comparing dialysis inception cohorts 1998-2002, 2003-2007, 2008-2012, and 2013-2017. SETTING & PARTICIPANTS Australia and New Zealand (ANZ) dialysis population. EXPOSURE The primary exposure was dialysis modality: facility hemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD), automated PD (APD), or home HD. OUTCOME The main outcome was death. ANALYTICAL METHODS Cause-specific proportional hazards models with shared frailty and subdistribution proportional hazards (Fine and Gray) models, adjusting for available confounding covariates. RESULTS In 52,097 patients, the overall death rate improved from ~15 deaths per 100 patient-years in 1998-2002 to ~11 in 2013-2017, with the largest cause-specific contribution from decreased infectious death. Relative to facility HD, mortality with CAPD and APD has improved over the years, with adjusted hazard ratios in 2013-2017 of 0.88 (95% CI, 0.78-0.99) and 0.91 (95% CI, 0.82-1.00), respectively. Increasingly, patients with lower clinical risk have been adopting APD, and to a lesser extent CAPD. Relative to facility HD, mortality with home HD was lower throughout the entire period of observation, despite increasing adoption by older patients and those with more comorbidities. All effects were generally insensitive to the modeling approach (initial vs time-varying modality, cause-specific versus subdistribution regression), different follow-up time intervals (5 year vs 7 year vs 10 year). There was no effect modification by diabetes, comorbidity, or sex. LIMITATIONS Potential for residual confounding, limited generalizability. CONCLUSIONS The survival of patients on PD in 2013-2017 appears greater than the survival for patients on facility HD in ANZ. Additional research is needed to assess whether changing clinical risk profiles over time, varied dialysis prescription, and morbidity from dialysis access contribute to these findings.
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Affiliation(s)
- Mark R Marshall
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Renal Medicine, Counties Manukau Health, Auckland, New Zealand.
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Health, Clayton, Australia; Department of Medicine, Department of Epidemiology and Preventive Medicine, Department of Nursing and Health Sciences, Monash University, Clayton, Australia; Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australia Health and Medical Research Institute, Adelaide, Australia
| | - Neil Boudville
- Medical School, University of Western Australia, Nedlands, Australia; Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Stephen P McDonald
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australia Health and Medical Research Institute, Adelaide, Australia; School of Medicine, University of Adelaide, Adelaide, Australia
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Gardiner FW, Bishop L, Gale L, Harwood A, Teoh N, Lucas RM, Jones M, Laverty M. Poor access to kidney disease management services in susceptible patient populations in rural Australia is associated with increased aeromedical retrievals for acute renal care. Intern Med J 2021; 50:951-959. [PMID: 31821680 DOI: 10.1111/imj.14716] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/11/2019] [Accepted: 11/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inequalities in access to renal services and acute care for rural and remote populations in Australia have been described but not quantified. AIM To describe: the coverage of renal disease management services in rural and remote Australia; and the characteristics of patients who had an aeromedical retrieval for renal disease by Australia's Royal Flying Doctor Service (RFDS). METHODS Data from the RFDS, the Australian Bureau of Statistics, and Health Direct were used to estimate provision of renal disease management services by geographic area. RFDS patient diagnostic data were prospectively collected from 2014 to 2018. RESULTS Many rural and remote areas have limited access to regular renal disease management services. Most RFDS retrievals for renal disease are from regions without such services. The RFDS conducted 1636 aeromedical retrievals for renal disease, which represented 1.6% of all retrievals. Among retrieved patients, there was a higher proportion of men than women (54.6% vs 45.4%, P < 0.01), while indigenous patients (n = 546, 33.4%) were significantly younger than non-indigenous patients (40.9 vs 58.5, P < 0.01). There were significant differences in underlying diagnoses triggering retrievals between genders, with males being more likely than females to be transferred with acute renal failure, calculus of the kidney and ureter, renal colic, obstructive uropathy, and kidney failure (all P < 0.01). Conversely, females were more likely to have chronic kidney disease, disorders of the urinary system, acute nephritic syndrome, tubulo-interstitial nephritis, and nephrotic syndrome (all P < 0.01). CONCLUSION Aeromedical retrievals for acute care were from rural areas without regular access to renal disease prevention or management services.
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Affiliation(s)
- Fergus W Gardiner
- The Royal Flying Doctor Service, Australia.,National Centre for Epidemiology and Population Health and The Australian National University Medical School, The Australian National University, Canberra, Australia
| | | | | | | | - Narci Teoh
- Medicine and Surgery Program, The Australian National University Medical School at The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health and The Australian National University Medical School, The Australian National University, Canberra, Australia
| | - Martin Jones
- University of South Australia Department of Rural Health, Whyalla, South Australia, Australia
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Plumb TJ, Alvarez L, Ross DL, Lee JJ, Mulhern JG, Bell JL, Abra GE, Prichard SS, Chertow GM, Aragon MA. Self-care training using the Tablo hemodialysis system. Hemodial Int 2020; 25:12-19. [PMID: 33047477 PMCID: PMC7891342 DOI: 10.1111/hdi.12890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/19/2020] [Accepted: 09/18/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Recently published results of the investigational device exemption (IDE) trial using the Tablo hemodialysis system confirmed its safety and efficacy for home dialysis. This manuscript reports additional data from the Tablo IDE study on the training time required to be competent in self-care, the degree of dependence on health care workers and caregivers after training was complete, and participants' assessment of the ease-of-use of Tablo. METHODS We collected data on the time required to set up concentrates and the Tablo cartridge prior to treatment initiation. We asked participants to rate system setup, treatment, and takedown on a Likert scale from 1 (very difficult) to 5 (very simple) and if they had required any assistance with any aspect of treatment over the prior 7 days. In a subgroup of 15 participants, we recorded the number of training sessions required to be deemed competent to do self-care dialysis. FINDINGS Eighteen men and 10 women with a mean age of 52.6 years completed the study. Thirteen had previous self-care experience using a different dialysis system. Mean set up times for the concentrates and cartridge were 1.1 and 10.0 minutes, respectively. Participants with or without previous self-care experience had similar set-up times. The mean ease-of-use score was 4.5 or higher on a scale from 1 to 5 during the in-home phase. Sixty-five percent required no assistance at home and on average required fewer than four training sessions to be competent in managing their treatments. Results were similar for participants with or without previous self-care experience. CONCLUSIONS Participants in the Tablo IDE trial were able to quickly learn and manage hemodialysis treatments in the home, found Tablo easy to use, and were generally independent in performing hemodialysis.
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Affiliation(s)
- Troy J Plumb
- University of Nebraska, Nebraska Medical Center, Omaha, Nebraska, 68198, USA
| | - Luis Alvarez
- Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, California, 94301, USA
| | - Dennis L Ross
- Kansas Nephrology Research Institute, 1007 N. Emporia, Wichita, Kansas, 67214, USA
| | - Joseph J Lee
- Nephrology Associates Medical Group, 3660 Park Sierra #208, Riverside, California, 92505, USA
| | - Jeffrey G Mulhern
- Fresenius Kidney Care Pioneer Valley Dialysis, 208 Ashley Ave, West Springfield, Massachusetts, 01089, USA
| | - Jeffrey L Bell
- Southwest Georgia Nephrology Clinic, 1200 North Jefferson Street, Albany, Georgia, 31701, USA
| | - Graham E Abra
- Stanford University, 300 Pasteur Drive, 1st floor, Suite A175, Stanford, California, 94305, USA
| | | | - Glenn M Chertow
- Stanford University School of Medicine, 1070 Arastradero Road, Palo Alto, California, 94034, USA
| | - Michael A Aragon
- DaVita Grapevine at Home, 1600 W. Northwest Hwy, Suite 100, Grapevine, Texas, 76051, USA
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Abstract
Rationale & Objective Community house hemodialysis is a submodality of home hemodialysis that enables patients to perform hemodialysis independent of nursing or medical supervision in a shared house. This study describes the perspectives and experiences of patients using community house hemodialysis in New Zealand to explore ways this dialysis modality may support the wider delivery of independent hemodialysis care. Study Design Qualitative semi-structured in-depth interview study. Setting & Participants 25 patients who had experienced community house hemodialysis. Participants were asked about why they chose community house hemodialysis and their experiences and perspectives of this. Analytical Approach Thematic analysis using an inductive approach. Results 25 patients were interviewed (14 men and 11 women, aged 31-65 years). Most were of Māori or Pacific ethnicity and in part- or full-time employment. More than two-thirds dialyzed for 20 hours a week or more. We identified 4 themes that described patients’ experiences and perspectives of choosing and using community house hemodialysis: reducing burden on family (when home is not an option, minimizing family exposure to dialysis, maintaining privacy and self-identity, reducing the costs of home hemodialysis, and gaining a reprieve from home), offering flexibility and freedom (having a normal life, maintaining employment, and facilitating travel), control of my health (building independence and self-efficacy, a place of wellness, avoiding institutionalization, and creating a culture of extended-hour dialysis), and community support (building social inclusion and supporting peers). Limitations Non-Māori and non-Pacific patient experiences of community house hemodialysis could not be explored. Conclusions Community house hemodialysis is a dialysis modality that overcomes many of the socioeconomic barriers to home hemodialysis, is socially and culturally acceptable to Māori and Pacific people, and supports extended-hour hemodialysis and thereby promotes more equitable access to best practice services. It is therefore a significant addition to independent hemodialysis options available for patients.
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Abra G, Schiller B. Public policy and programs – Missing links in growing home dialysis in the United States. Semin Dial 2020; 33:75-82. [DOI: 10.1111/sdi.12850] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Graham Abra
- Satellite Healthcare San Jose CA USA
- Division of Nephrology Department of Medicine Stanford University Palo Alto CA USA
| | - Brigitte Schiller
- Satellite Healthcare San Jose CA USA
- Division of Nephrology Department of Medicine Stanford University Palo Alto CA USA
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Campbell MA, Hunt J, Scrimgeour DJ, Davey M, Jones V. Contribution of Aboriginal Community-Controlled Health Services to improving Aboriginal health: an evidence review. AUST HEALTH REV 2019; 42:218-226. [PMID: 28263705 DOI: 10.1071/ah16149] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/20/2016] [Indexed: 11/23/2022]
Abstract
Objective Aboriginal Community-Controlled Health Services (ACCHSs) deliver comprehensive, culturally appropriate primary health care to Aboriginal people and communities. The published literature acknowledging and supporting the roles of ACCHSs in improving Aboriginal health is limited. This paper seeks to collate and analyse the published evidence supporting the contribution of ACCHSs to improving the health of Aboriginal people. Methods A conceptual framework for exploring the contribution of ACCHSs was developed, drawing on the literature on the core functions of ACCHSs and the components of quality primary health care. This framework was used to structure the search strategy, inclusion criteria and analysis of the review. Results ACCHSs contribute to improving the health and well being of Aboriginal peoples through several pathways, including community controlled governance, providing employment and training, strengthening the broader health system and providing accessible, comprehensive primary health care. Conclusions ACCHSs make a range of important contributions to improving the health of Aboriginal peoples that are under-acknowledged. Consideration of the different ways ACCHSs contribute to improving Aboriginal health is of value in the design and evaluation of programs and policies that aim to improve the health of Aboriginal peoples. What is known about the topic? Aboriginal communities have long argued the vital role of ACCHSs in improving Aboriginal health. What does this paper add? This paper provides a comprehensive collation and analysis of the evidence supporting the contributions ACCHSs are making to improving Aboriginal health. What are the implications for practitioners? The conceptual framework and findings outlined in this paper illustrate that ACCHSs are making important contributions to improving Aboriginal health through several pathways. This information can be used to ensure actions to improve Aboriginal health are appropriate and effective. There are important gaps in the literature that researchers need to address.
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Affiliation(s)
- Megan Ann Campbell
- Aboriginal Health & Medical Research Council, Level 3, 66 Wentworth Avenue, Surry Hills, NSW 2010, Australia.
| | - Jennifer Hunt
- Aboriginal Health & Medical Research Council, Level 3, 66 Wentworth Avenue, Surry Hills, NSW 2010, Australia.
| | - David J Scrimgeour
- Spinifex Health Service, PMB 88, via Kalgoorlie, WA 6430, Australia. Email
| | - Maureen Davey
- Tasmanian Aboriginal Centre, 198 Elizabeth Street, Hobart, Tas. 7001, Australia. Email
| | - Victoria Jones
- Aboriginal Health & Medical Research Council, Level 3, 66 Wentworth Avenue, Surry Hills, NSW 2010, Australia.
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Krishnan A, Irani K, Swaminathan R, Boan P. A retrospective study of tunnelled haemodialysis central line-associated bloodstream infections. J Chemother 2019; 31:132-136. [PMID: 30935344 DOI: 10.1080/1120009x.2019.1595894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Infection is a serious complication of tunnelled haemodialysis catheters. We aimed to describe the epidemiology of tunnelled haemodialysis central line-associated bloodstream infections (CLABSI) in an Australian centre. We performed a retrospective audit of tunnelled haemodialysis CLABSI from June 2010 to June 2014. From 674 catheter insertions, 70 CLABSI occurred in 55 patients at a rate of 0.95 infections per 1000 catheter days. Aboriginal and Torres Strait Islanders (ATSI) compared to non-ATSI had a higher rate of CLABSI (1.70 vs 0.58 CLABSI per 1000 catheter days, p < 0.001). Staphylococcus aureus (n = 22, 31.4%), coagulase negative Staphylococci (n = 14, 17.5%), and Gram negative bacilli (n = 28, 35.0%) were the predominant causative organisms. Two patients who died both had Staphylococcus aureus infection. In conclusion, our infection rate and microbiology are similar to prior reports. Morbidity and mortality are associated with Staphylococcus aureus as the causative organism.
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Affiliation(s)
- Anoushka Krishnan
- a Department of Nephrology and Renal Transplantation , Royal Perth Hospital , Perth , Western Australia , Australia
| | - Khushnam Irani
- a Department of Nephrology and Renal Transplantation , Royal Perth Hospital , Perth , Western Australia , Australia
| | - Ramyasuda Swaminathan
- b Department of Nephrology and Renal Transplantation , Fiona Stanley Hospital , Perth Western Australia , Australia
| | - Peter Boan
- c Departments of Microbiology and Infectious Diseases , PathWest Laboratory Medicine and Fiona Stanley Hospital , Perth , Western Australia , Australia
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Mohan JV, Atkinson DN, Rosman JB, Griffiths EK. Acute kidney injury in Indigenous Australians in the Kimberley: age distribution and associated diagnoses. Med J Aust 2019; 211:19-23. [PMID: 30860606 DOI: 10.5694/mja2.50061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/30/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe the frequencies of acute kidney injury (AKI) and of associated diagnoses in Indigenous people in a remote Western Australian region. DESIGN Retrospective population-based study of AKI events confirmed by changes in serum creatinine levels. SETTING, PARTICIPANTS Aboriginal and Torres Strait Islander residents of the Kimberley region of Western Australia, aged 15 years or more and without end-stage kidney disease, for whom AKI between 1 June 2009 and 30 May 2016 was confirmed by an acute rise in serum creatinine levels. MAIN OUTCOME MEASURES Age-specific AKI rates; principal and other diagnoses. RESULTS 324 AKI events in 260 individuals were recorded; the median age of patients was 51.8 years (IQR, 43.9-61.0 years), and 176 events (54%) were in men. The overall AKI rate was 323 events (95% CI, 281-367) per 100 000 population; 92 events (28%) were in people aged 15-44 years. 52% of principal diagnoses were infectious in nature, including pneumonia (12% of events), infections of the skin and subcutaneous tissue (10%), and urinary tract infections (7.7%). 80 events (34%) were detected on or before the date of admission; fewer than one-third of discharge summaries (61 events, 28%) listed AKI as a primary or other diagnosis. CONCLUSION The age distribution of AKI events among Indigenous Australians in the Kimberley was skewed to younger groups than in the national data on AKI. Infectious conditions were common in patients, underscoring the significance of environmental determinants of health. Primary care services can play an important role in preventing community-acquired AKI; applying pathology-based criteria could improve the detection of AKI.
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Affiliation(s)
- Joseph V Mohan
- The University of Western Australia, Perth, WA.,Rural Clinical School of Western Australia, University of Western Australia, Broome, WA
| | - David N Atkinson
- Rural Clinical School of Western Australia, University of Western Australia, Broome, WA
| | | | - Emma K Griffiths
- Rural Clinical School of Western Australia, University of Western Australia, Broome, WA.,Kimberley Aboriginal Medical Services, Broome, WA
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Manns B, Agar JWM, Biyani M, Blake PG, Cass A, Culleton B, Kleophas W, Komenda P, Lobbedez T, MacRae J, Marshall MR, Scott-Douglas N, Srivastava V, Magner P. Can economic incentives increase the use of home dialysis? Nephrol Dial Transplant 2018; 34:731-741. [DOI: 10.1093/ndt/gfy223] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Braden Manns
- Departments of Medicine and Community Health Sciences, O’Brien Institute of Public Health and Libin Cardiovascular Institute, University of Calgary, AB, Canada
| | - John W M Agar
- Department of Renal Medicine, University Hospital Geelong, Geelong, VIC, Australia
| | - Mohan Biyani
- Department of Medicine, University of Ottawa, ON, Canada
| | - Peter G Blake
- Department of Medicine, University of Western Ontario, ON, Canada
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Werner Kleophas
- MVZ Davita Düsseldorf, Düsseldorf, Germany
- Department of Nephrology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Paul Komenda
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Thierry Lobbedez
- Nephrology Department of the University Hospital of Caen, Caen, France
| | | | - Mark R Marshall
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Renal Medicine, Counties Manukau Health, Auckland, New Zealand
- Baxter Healthcare (Asia) Pte Ltd, Singapore
| | | | | | - Peter Magner
- Department of Medicine, University of Ottawa, ON, Canada
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Hyde Z, Smith K, Flicker L, Atkinson D, Almeida OP, Lautenschlager NT, Dwyer A, LoGiudice D. Mortality in a cohort of remote-living Aboriginal Australians and associated factors. PLoS One 2018; 13:e0195030. [PMID: 29621272 PMCID: PMC5886486 DOI: 10.1371/journal.pone.0195030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 03/15/2018] [Indexed: 11/29/2022] Open
Abstract
Objectives We aimed to describe mortality in a cohort of remote-living Aboriginal Australians using electronic record linkage. Methods Between 2004 and 2006, 363 Aboriginal people living in remote Western Australia (WA) completed a questionnaire assessing medical history and behavioural risk factors. We obtained mortality records for the cohort from the WA Data Linkage System and compared them to data for the general population. We used Cox proportional hazards regression to identify predictors of mortality over a 9-year follow-up period. Results The leading causes of mortality were diabetes, renal failure, and ischaemic heart disease. Diabetes and renal failure accounted for 28% of all deaths. This differed from both the Australian population as a whole, and the general Indigenous Australian population. The presence of chronic disease did not predict mortality, nor did behaviours such as smoking. Only age, male sex, poor mobility, and cognitive impairment were risk factors. Conclusions To reduce premature mortality, public health practitioners should prioritise the prevention and treatment of diabetes and renal disease in Aboriginal people in remote WA. This will require a sustained and holistic approach.
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Affiliation(s)
- Zoë Hyde
- Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Kate Smith
- Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - David Atkinson
- Rural Clinical School of WA, University of Western Australia, Perth, Australia
- Kimberley Aboriginal Medical Services, Broome, Australia
| | - Osvaldo P. Almeida
- Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Nicola T. Lautenschlager
- Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Australia
- NorthWestern Mental Health, Melbourne Health, Melbourne, Australia
| | - Anna Dwyer
- Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia
- Nulungu Research Institute, University of Notre Dame, Broome, Australia
| | - Dina LoGiudice
- Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia
- Aged Care, Melbourne Health and University of Melbourne, Melbourne, Australia
- * E-mail:
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16
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Carson E, Sharmin S, Maier AB, Meij JJ. Comparing indigenous mortality across urban, rural and very remote areas: a systematic review and meta-analysis. Int Health 2018; 10:219-227. [DOI: 10.1093/inthealth/ihy021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 02/24/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Edward Carson
- Department of Medicine and Aged Care, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sifat Sharmin
- Department of Medicine and Aged Care, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Melbourne Academic Centre for Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Human Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - Johannes J Meij
- Melbourne Academic Centre for Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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17
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Marley JV, Moore S, Fitzclarence C, Warr K, Atkinson D. Peritoneal dialysis outcomes of Indigenous Australian patients of remote Kimberley origin. Aust J Rural Health 2016; 22:101-8. [PMID: 25039843 PMCID: PMC4140604 DOI: 10.1111/ajr.12086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2013] [Indexed: 11/29/2022] Open
Abstract
Objectives To compare clinical outcomes and mortality rates between Kimberley Indigenous, other Indigenous and non-Indigenous Australian patients on peritoneal dialysis (PD). Design and participants Patients commencing renal replacement therapy (RRT) with PD for the first time from 1 January 2003 to 31 December 2009 were retrospectively identified. Secondary data from medical records and the Australian and New Zealand Dialysis and Transplant Registry from 1 January 2003 to 31 December 2010 were used to compare outcomes between patients. Main outcome measures Time to first peritonitis; failure and death rates per 100 patient-years, hazard ratios, unadjusted and adjusted (for age, sex, comorbid conditions, PD not the first RRT modality used). Comparison of the two PD systems used in the Kimberley. Results Kimberley patients had significantly shorter median time to first peritonitis (11.2 versus 21.5 months), higher technique failure (46.0 versus 25.2 per 100 patient-years) and shorter median survival on PD (17.5 versus 22.4 months) but similar adjusted mortality (hazard ratio 1.32; 95% CI, 0.76-2.29) as non-Indigenous patients. They also had a significantly higher technique failure rate than other Indigenous patients (46.0 versus 31.4 per 100 patient-years) and nearly double the average peritonitis episodes previously reported for Indigenous Australians (2.0 versus 1.15 per patient-year). Conclusions PD can bring patients closer to home; however, it is relatively short term and potentially hazardous. PD remains an important therapy for suitable remote patients to get closer to home, providing they are fully informed of the options. The current expansion of safer Kimberley haemodialysis options needs to continue.
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Affiliation(s)
- Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia; Kimberley Aboriginal Medical Services Council, Broome, Western Australia, Australia
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Lawton PD, Cunningham J, Zhao Y, Gray NA, Chatfield MD, Baade PD, Murali K, Jose MD. Survival of Indigenous Australians receiving renal replacement therapy: closing the gap? Med J Aust 2015; 202:200-4. [PMID: 25716603 DOI: 10.5694/mja14.00664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 09/22/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare mortality rates for Indigenous and non-Indigenous Australians commencing renal replacement therapy (RRT) over time and by categories of remoteness of place of residence. DESIGN, SETTING AND PARTICIPANTS An observational cohort study of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data on Indigenous and non-Indigenous Australians registered with ANZDATA who commenced RRT from 1 January 1995 to 31 December 2009 and were followed until 31 December 2011. MAIN OUTCOME MEASURES Five-year all-cause mortality for Indigenous and non-Indigenous patients in three cohorts (1995-1999, 2000-2004 and 2005-2009) and five remoteness (of place of residence) categories. RESULTS Indigenous patients were younger, more likely to have diabetes, be referred late and be from a more remote area than non-Indigenous patients. Age and comorbid conditions increased with successive cohorts for both groups. Unadjusted analysis (using the log-rank test) showed an increased risk of death for Indigenous patients in the 1995-1999 (P = 0.02) and 2000-2004 (P = 0.03) cohorts, but not for the 2005-2009 cohort (P = 0.7). However, a Cox proportional hazards model adjusted for covariates (age, sex, late referral and comorbid conditions [diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, lung disease], and body mass index < 18.5 kg/m(2) and > 30 kg/m(2)) showed the following Indigenous:non-Indigenous hazard ratios (with 95% CIs) for major capital cities: 1995-1999, 1.47 (1.21-1.79); 2000-2004, 1.35 (1.12-1.63); and 2005-2009, 1.37 (1.14-1.66). CONCLUSIONS Although unadjusted analysis suggests that the survival gap between Indigenous and non-Indigenous patients receiving RRT has closed, there remains a significant disparity in survival after adjusting for the variables considered in our study.
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Affiliation(s)
- Paul D Lawton
- Menzies School of Health Research, Darwin, NT, Australia.
| | | | - Yuejen Zhao
- Northern Territory Department of Health, Darwin, NT, Australia
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Walker RC, Blagg CR, Mendelssohn DC. Systems to cultivate suitable patients for home dialysis. Hemodial Int 2015; 19 Suppl 1:S52-8. [PMID: 25925824 DOI: 10.1111/hdi.12203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The key to developing, initiating, and maintaining a strong home dialysis program is a fundamental commitment by the entire team to identify and cultivate patients who are suitable candidates to perform home dialysis. This process must start as early as possible in the disease trajectory, and must include a passionate and daily focus by physicians, nurses, social workers, and other members of the multidisciplinary team. This effort must be constant and sustained over months, with active promotion of home dialysis for suitable patients at every opportunity. Cultivation of suitable patients must become a defining and overarching mission for the entire program. This article reviews some of the components involved in this worthwhile effort and provides practical tips and links to resources.
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Affiliation(s)
- Rachael C Walker
- Renal Department, Hawke's Bay District Health Board, Hastings, New Zealand; School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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20
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Agar JW, Perkins A, Heaf JG. Home hemodialysis: Infrastructure, water, and machines in the home. Hemodial Int 2015; 19 Suppl 1:S93-S111. [DOI: 10.1111/hdi.12290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- John W. Agar
- Renal Unit; Barwon Health; Geelong Victoria Australia
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Smyth W, Hartig V, Hayes M, Manickam V. Patients' adherence to aspects of haemodialysis regimens in tropical north Queensland, Australia. J Ren Care 2015; 41:110-8. [PMID: 25597887 DOI: 10.1111/jorc.12108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with end-stage kidney disease often have difficulty in adhering to aspects of their haemodialysis regimens. OBJECTIVES This study aimed to quantify the number of patients who attended 100% of their scheduled haemodialysis sessions, and the number of patients who gained no more than one kilogram per day between dialysis sessions, over a three-month period. DESIGN Retrospective chart audit PARTICIPANTS Patients undergoing haemodialysis at an in-hospital centre in tropical Australia. METHODS A renal nurse audited the 72 charts pertaining to a 12-week period in 2013. RESULTS Patients attended 90.1% of all scheduled dialysis sessions. Forty-one patients attended all sessions, with the remaining 31 missing at least one scheduled session. One patient missed 16 scheduled sessions. The following were statistically less likely to attend all their scheduled sessions: Aboriginal and Torres Strait Islander patients; patients on a three times per week dialysis schedule; patients who had relocated from rural or regional towns and younger patients. The average daily weight gain ranged from 0.414 kg to 1.017 kg (mean = 0.885 kg). Younger patients were statistically less likely to adhere to fluid restrictions; patients without diabetes were more likely to adhere to the fluid allowances. CONCLUSIONS AND APPLICATIONS TO PRACTICE Renal services need to assist patients to adhere to their regimens. Initially, this service will examine strategies to maximise the likelihood of patients attending all of their dialysis sessions. Such an outcome will help to delay deterioration in the patients' health status, while minimising additional strain on the health service.
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Affiliation(s)
- Wendy Smyth
- Townsville Hospital and Health Service; and Nursing, Midwifery and Nutrition, College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Vicki Hartig
- Clinical Nurse Consultant, Townsville Renal Service, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Megan Hayes
- Consultant Nephrologist, Townsville Renal Service, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Valli Manickam
- Student Nurse, Nursing, Midwifery and Nutrition, College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
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22
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Hoy WE. Kidney disease in Aboriginal Australians: a perspective from the Northern Territory. Clin Kidney J 2014; 7:524-30. [PMID: 25503952 PMCID: PMC4240408 DOI: 10.1093/ckj/sfu109] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/01/2014] [Indexed: 02/01/2023] Open
Abstract
This article outlines the increasing awareness, service development and research in renal disease in Aboriginal people in Australia's Northern Territory, among whom the rates of renal replacement therapy (RRT) are among the highest in the world. Kidney failure and RRT dominate the intellectual landscape and consume the most professional energy, but the underlying kidney disease has recently swung into view, with increasing awareness of its connection to other chronic diseases and to health profiles and trajectories more broadly. Albuminuria is the marker of the underlying kidney disease and the best treatment target, and glomerulomegaly and focal glomerulosclerosis are the defining histologic features. Risk factors in its multideterminant genesis reflect nutritional and developmental disadvantage and inflammatory/infectious milieu, while the major putative genetic determinants still elude detection. A culture shift of "chronic disease prevention" has been catalyzed in part by the human pain, logistic problems and great costs associated with RRT. Nowadays chronic disease management is the central focus of indigenous primary care, with defined protocols for integrated testing and management of chronic diseases and with government reimbursed service items and free medicines for people in remote areas. Blood pressure, cardiovascular risk and chronic kidney disease (CKD) are all mitigated by good treatment, which centres on renin-angiotensin system blockade and good metabolic control. RRT incidence rates appear to be stabilizing in remote Aboriginal people, and chronic disease deaths rates are falling. However, the profound levels of disadvantage in many remote settings remain appalling, and there is still much to be done, mostly beyond the direct reach of health services.
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Affiliation(s)
- Wendy E Hoy
- Centre for Chronic Disease, School of Medicine , The University of Queensland , Brisbane, Queensland 4029 , Australia
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Todd A, Carroll R, Gallagher M, Meade A. Nutritional status of haemodialysis patients: comparison of Australian cohorts of Aboriginal and European descent. Nephrology (Carlton) 2014; 18:790-7. [PMID: 24118237 DOI: 10.1111/nep.12165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2013] [Indexed: 11/26/2022]
Abstract
AIM It is not known whether nutritional status differs between Australian Aboriginal and non Aboriginal haemodialysis subjects. The aim of this study was to investigate the nutritional status of Australian Aboriginal and non-Aboriginal haemodialysis subjects at satellite dialysis centres. METHOD Seventy-six (25 Aboriginal, 51 non-Aboriginal) prevalent haemodialysis patients were enrolled in a 3-month cross-sectional study. Each month anthropometric and biochemical measurements were collected. Nutritional status (diet history, patient-generated subjective global assessment (PG-SGA), handgrip strength) was assessed by a dietitian. RESULTS PG-SGA detected mild to moderate malnutrition in 35% of Aboriginal patients and 25% of non-Aboriginal patients. The overall physical rating on the PG-SGA was significantly higher in Aboriginal patients, indicating the presence of a greater deficit in muscle mass in this population. Inter-dialytic weight gain was significantly greater in Aboriginal subjects (median [range] 3.0 [2.1-5.7] vs 2.5 [-0.3-5.0] kg, P<0.001). Glucose and HbA1c were significantly higher in Aboriginal subjects with diabetes than in non-Aboriginal patients with diabetes (median [range] 9.4 [4.9-23.4] vs 5.7 [3.1-12.9], P=0.002; 7.0 [5.2-11.0] vs 5.8 [4.6-9.0], P<0.000; respectively). These findings occurred in the setting of each cohort having adequate dialysis parameters (median Kt/V of >1.6 and median normalized protein catabolic rate 1.5). Difficulties were encountered in obtaining dietary information from Aboriginal subjects using the diet history method. CONCLUSION Subjects had acceptable parameters of dialysis adequacy; however, 35% had evidence of malnutrition. Further research should focus on establishing a knowledge base for the nutritional management for Aboriginal dialysis subjects, and the development of a validated individual dietary assessment method for use in this population group.
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Affiliation(s)
- Alwyn Todd
- Department of Nutrition and Dietetics, Mater Health Services, Brisbane, Queensland, Australia; Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia; Department of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
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Mc Loughlin F, Hadgraft NT, Atkinson D, Marley JV. Aboriginal health research in the remote Kimberley: an exploration of perceptions, attitudes and concerns of stakeholders. BMC Health Serv Res 2014; 14:517. [PMID: 25343849 PMCID: PMC4213490 DOI: 10.1186/s12913-014-0517-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 10/13/2014] [Indexed: 11/10/2022] Open
Abstract
Background For decades Indigenous peoples have argued for health research reform claiming methods used and results obtained often reflect the exploitative history of colonisation. In 2006 the Kimberley Aboriginal Health Planning Forum (KAHPF) Research Subcommittee (hereafter, the Subcommittee) was formed to improve research processes in the remote Kimberley region of north Western Australia. This paper explores the major perceptions, attitudes and concerns of stakeholders in the Subcommittee. Methods Qualitative analysis was carried out on data retrospectively collected from multiple evidentiary sources linked to the Subcommittee i.e. database, documents, interviews, review forms and emails from 1 January 2007 to 31 October 2013. Results From 1 January 2007 to 30 June 2013 the Subcommittee received 95 proposals, 57 (60%) driven by researchers based outside the region. Local stakeholders (22 from 12 different Kimberley organisations) raised concerns about 36 (38%) projects, 30 (83%) of which were driven by external researchers. Major concerns of local stakeholders were inadequate community consultation and engagement; burden of research on the region; negative impact of research practices; lack of demonstrable community benefit; and power and control of research. Major themes identified by external stakeholders (25 external researchers who completed the review form) were unanticipated difficulties with consultation processes; barriers to travel; perceiving research as a competing priority for health services and time-consuming ethics processes. External stakeholders also identified strategies for improving research practices in the Kimberley: importance of community support in building good relationships; employing local people; flexibility in research approaches; and importance of allocating sufficient time for consultation and data collection. Conclusions Health research in the Kimberley has improved in recent years, however significant problems remain. Prioritising research addressing genuine local needs is essential in closing the gap in Indigenous life expectancy. The long-term aim is for local health service connected researchers to identify priorities, lead, conduct and participate in the majority of local health research. For this to occur, a more radical move involving reconceptualising the research process is needed. Changes to institutional timeframes and funding processes could improve Indigenous and community-based research.
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Affiliation(s)
- Frieda Mc Loughlin
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia.
| | - Nyssa T Hadgraft
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia.
| | - David Atkinson
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia. .,The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia.
| | - Julia V Marley
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia. .,The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia.
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McKercher C, Chan HW, Clayton PA, McDonald S, Jose MD. Dialysis outcomes of elderly Indigenous and non-Indigenous Australians. Nephrology (Carlton) 2014; 19:610-6. [DOI: 10.1111/nep.12317] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Charlotte McKercher
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tasmania Australia
| | - Hoi Wong Chan
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tasmania Australia
- Renal Unit; Queen Elizabeth Hospital; Hong Kong
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry; Adelaide South Australia Australia
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry; Adelaide South Australia Australia
| | - Matthew D Jose
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tasmania Australia
- School of Medicine; University of Tasmania; Hobart Tasmania Australia
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Rix EF, Barclay L, Stirling J, Tong A, Wilson S. 'Beats the alternative but it messes up your life': aboriginal people's experience of haemodialysis in rural Australia. BMJ Open 2014; 4:e005945. [PMID: 25231493 PMCID: PMC4166141 DOI: 10.1136/bmjopen-2014-005945] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Australian Aboriginal people have at least eight times the incidence of end-stage kidney disease, requiring dialysis, as the non-Aboriginal population. Provision of health services to rural Aboriginal people with renal disease is challenging due to barriers to access and cultural differences. We aimed to describe the experiences of Aboriginal people receiving haemodialysis in rural Australia, to inform strategies for improving renal services. DESIGN A qualitative design incorporating: Indigenist research methodology and Community Based Participatory Research principles. In-depth interviews used a 'yarning' and storytelling approach. Thematic analysis was undertaken and verified by an Aboriginal Community Reference Group. SETTING A health district in rural New South Wales, Australia. PARTICIPANTS Snowball sampling recruited 18 Aboriginal haemodialysis recipients. RESULTS Six themes emerged which described the patient journey: 'The biggest shock of me life,' expressed the shock of diagnosis and starting the dialysis; 'Beats the alternative but it messes up your life,' explained how positive attitudes to treatment develop; 'Family is everything', described the motivation and support to continue dialysis; 'If I had one of them nurses at home to help me', depicted acute hospital settings as culturally unsafe; 'Don't use them big jawbreakers', urged service providers to use simple language and cultural awareness; 'Stop 'em following us onto the machine', emphasised the desire for education for the younger generations about preventing kidney disease. An Aboriginal interpretation of this experience, linked to the analysis, was depicted in the form of an Aboriginal painting. CONCLUSIONS Family enables Aboriginal people to endure haemodialysis. Patients believe that priorities for improving services include family-centred and culturally accommodating healthcare systems; and improving access to early screening of kidney disease. Inclusion of Aboriginal patients in cultural education for renal staff is recommended. Providing opportunities for patients to educate young Aboriginal people about kidney disease prevention may be highly effective and empowering.
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Affiliation(s)
- Elizabeth F Rix
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Lesley Barclay
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Janelle Stirling
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Shawn Wilson
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
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Marley JV, Kitaura T, Atkinson D, Metcalf S, Maguire GP, Gray D. Clinical trials in a remote Aboriginal setting: lessons from the BOABS smoking cessation study. BMC Public Health 2014; 14:579. [PMID: 24912949 PMCID: PMC4064520 DOI: 10.1186/1471-2458-14-579] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 06/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two smoking cessation randomised controlled trials (RCTs) investigating this suggests that one-on-one extra support delivered by and provided to Indigenous Australians in a primary health care setting appears to be more effective than usual care in encouraging smoking cessation. This paper describes the lessons learnt from one of these studies, the Be Our Ally Beat Smoking (BOABS) Study, and how to develop and implement an integrated smoking cessation program. METHODS Qualitative study using data collected from multiple documentary sources related to the BOABS Study. As the project neared completion the research team participated in four workshops to review and conduct thematic analyses of these documents. RESULTS Challenges we encountered during the relatively complex BOABS Study included recruiting sufficient number of participants; managing the project in two distant locations and ensuring high quality work across both sites; providing appropriate training and support to Aboriginal researchers; significant staff absences, staff shortages and high workforce turnover; determining where and how the project fitted in the clinics and consequent siloing of the Aboriginal researchers relating to the requirements of RCTs; resistance to change, and maintaining organisational commitment and priority for the project. The results of this study also demonstrated the importance of local Aboriginal ownership, commitment, participation and control. This included knowledge of local communities, the flexibility to adapt interventions to local settings and circumstances, and taking sufficient time to allow this to occur. CONCLUSIONS The keys to the success of the BOABS Study were local development, ownership and participation, worker professional development and support, and operating within a framework of cultural safety. There were difficulties associated with the BOABS Study being an RCT, and many of these are shared with stand-alone programs. Interventions targeted at particular health problems are best integrated with usual primary health care. Research to investigate complex interventions in Indigenous health should not be limited to randomised clinical trials and funding needs to reflect the additional, but necessary, cost of providing for local control of planning and implementation.
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Affiliation(s)
- Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, Western Australia 6725, Australia
| | - Tracey Kitaura
- Derby Aboriginal Health Service, 1 Stanley Street, PO Box 1155, Derby, Western Australia 6728, Australia
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, Western Australia 6725, Australia
| | - Sue Metcalf
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, Western Australia 6725, Australia
| | - Graeme P Maguire
- School of Medicine and Dentistry, James Cook University, Cairns, Queensland 4870, Australia
- Baker IDI, Alice Springs, Northern Territory 0871, Australia
| | - Dennis Gray
- National Drug Institute, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
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Marley JV, Atkinson D, Kitaura T, Nelson C, Gray D, Metcalf S, Maguire GP. The Be Our Ally Beat Smoking (BOABS) study, a randomised controlled trial of an intensive smoking cessation intervention in a remote aboriginal Australian health care setting. BMC Public Health 2014; 14:32. [PMID: 24418597 PMCID: PMC3905726 DOI: 10.1186/1471-2458-14-32] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 12/20/2013] [Indexed: 11/25/2022] Open
Abstract
Background Australian Aboriginal and Torres Strait Islander peoples (Indigenous Australians) smoke at much higher rates than non-Indigenous people and smoking is an important contributor to increased disease, hospital admissions and deaths in Indigenous Australian populations. Smoking cessation programs in Australia have not had the same impact on Indigenous smokers as on non-Indigenous smokers. This paper describes the outcome of a study that aimed to test the efficacy of a locally-tailored, intensive, multidimensional smoking cessation program. Methods A randomised controlled trial of Aboriginal researcher delivered tailored smoking cessation counselling during face-to-face visits, aiming for weekly for the first four weeks, monthly to six months and two monthly to 12 months. The control (“usual care”) group received routine care relating to smoking cessation at their local primary health care service. Data collection occurred at enrolment, six and 12 months. The primary outcome was self-reported smoking cessation with urinary cotinine confirmation at final follow-up (median 13 (interquartile range 12–15) months after enrolment). Results Participants in the intervention (n = 55) and usual care (n = 108) groups were similar in baseline characteristics, except the intervention group was slightly older. At final follow-up the smoking cessation rate for participants assigned to the intervention group (n = 6; 11%), while not statistically significant, was double that of usual care (n = 5; 5%; p = 0.131). A meta-analysis of these findings and a similarly underpowered but comparable study of pregnant Indigenous Australian women showed that Indigenous Australian participants assigned to the intervention groups were 2.4 times (95% CI, 1.01-5.5) as likely to quit as participants assigned to usual care. Conclusions Culturally appropriate, multi-dimensional Indigenous quit smoking programs can be successfully implemented in remote primary health care. Intensive one-on-one interventions with substantial involvement from Aboriginal and Torres Strait Islander workers are likely to be effective in these settings. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12608000604303).
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Affiliation(s)
- Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia.
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Rix EF, Barclay L, Wilson S, Stirling J, Tong A. Service providers' perspectives, attitudes and beliefs on health services delivery for Aboriginal people receiving haemodialysis in rural Australia: a qualitative study. BMJ Open 2013; 3:e003581. [PMID: 24157820 PMCID: PMC3808758 DOI: 10.1136/bmjopen-2013-003581] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Providing services to rural dwelling minority cultural groups with serious chronic disease is challenging due to access to care and cultural differences. This study aimed to describe service providers' perspectives on health services delivery for Aboriginal people receiving haemodialysis for end-stage kidney disease in rural Australia. DESIGN Semistructured interviews, thematic analysis SETTING A health district in rural New South Wales, Australia PARTICIPANTS Using purposive sampling, 29 renal and allied service providers were recruited, including nephrologists, renal nurses, community nurses, Aboriginal health workers, social workers and managers. Six were Aboriginal and 23 non-Aboriginal. RESULTS Improving cultural understanding within the healthcare system was central to five themes identified: rigidity of service design (outreach, inevitable home treatment failures, pressure of system overload, limited efficacy of cultural awareness training and conflicting priorities in acute care); responding to social complexities (respecting but challenged by family obligations, assumptions about socioeconomic status and individualised care); promoting empowerment, trust and rapport (bridging gaps in cultural understanding, acknowledging the relationship between land, people and environment, and being time poor); distress at late diagnosis (lost opportunities and prioritise prevention); and contending with discrimination and racism (inherent judgement of lifestyle choices, inadequate cultural awareness, pervasive multilevel institutionalised racism and managing patient distrust). CONCLUSIONS Service providers believe current services are not designed to address cultural needs and Aboriginality, and that caring for Aboriginal patients receiving haemodialysis should be family focused and culturally safer. An Aboriginal-specific predialysis pathway, building staff cultural awareness and enhancing cultural safety within hospitals are the measures recommended. Increasing patient support for home haemodialysis may improve health and the quality of care outcomes.
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Affiliation(s)
- Elizabeth F Rix
- University Centre for Rural Health, School of Public Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Lesley Barclay
- University Centre for Rural Health, School of Public Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Shawn Wilson
- University Centre for Rural Health, School of Public Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Janelle Stirling
- University Centre for Rural Health, School of Public Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Allison Tong
- The Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Marshall MR, van der Schrieck N, Lilley D, Supershad SK, Ng A, Walker RC, Dunlop JL. Independent Community House Hemodialysis as a Novel Dialysis Setting: An Observational Cohort Study. Am J Kidney Dis 2013; 61:598-607. [DOI: 10.1053/j.ajkd.2012.10.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 10/20/2012] [Indexed: 11/11/2022]
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Grace BS, Clayton P, McDonald SP. Increases in renal replacement therapy in Australia and New Zealand: understanding trends in diabetic nephropathy. Nephrology (Carlton) 2012; 17:76-84. [PMID: 21854505 DOI: 10.1111/j.1440-1797.2011.01512.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The incidence of end-stage kidney disease (ESKD) has been increasing worldwide, with increasing numbers of older people, people with diabetic nephropathy and indigenous people. We investigated the incidence of renal replacement therapy (RRT) in Australia and New Zealand (NZ) to better understand the causes of these effects. METHODS Data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA)registry and relevant population data were used to investigate the incidence of RRT in five demographic groups: Indigenous and non-indigenous Australians, Māori, Pacific Islanders and other New Zealanders, as well as differences between genders and age groups. RESULTS The numbers of patients commencing RRT each year increased by 321% between 1990 and 2009. This increase was largely driven by increases in patients with diabetic nephropathy. In 2009 35% of new patients had ESKD resulting from diabetic nephropathy 92% of which were type 2. Indigenous Australians, and Māori and Pacific people of NZ have elevated risks of commencing RRT due to diabetic nephropathy, although the risks compared with non-indigenous Australians have decreased over time. A small element of lead time bias also contributed to this increase. Males are more likely to commence RRT due to diabetes than females, except among Australian Aborigines, where females are more at risk. There is a marked increase in older, more comorbid patients. CONCLUSIONS Patterns of incident renal replacement therapy strongly reflect the prevalence of diabetes within these groups. In addition, other factors such as reduced risk of dying before reaching ESKD, and increased acceptance of older and sicker patients are also contributing to increases in incidence of RRT.
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Affiliation(s)
- Blair S Grace
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Adelaide, South Australia, Australia.
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Prakash S. An International Perspective on Peritoneal Dialysis among Indigenous Patients. Perit Dial Int 2011; 31:390-8. [DOI: 10.3747/pdi.2010.00228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To review utilization rates, outcomes, and barriers to peritoneal dialysis (PD) in indigenous peoples from an international perspective. Methods Articles were obtained from Medline and EMBASE and from author name and reference searches. Data from census bureaus and renal registries in Australia, Canada, New Zealand, and the United States were used. Studies were included if they contained information on utilization of, outcomes of, or barriers to PD in indigenous populations. Results In 2007, of all prevalent PD patients, 7.0%, 5.1%, 28.2%, and 1.3% in Australia, Canada, New Zealand, and the United States respectively were of indigenous background. The proportions of prevalent renal replacement therapy patients on PD reflected the national rates—New Zealand being the highest at 0.29, and the United States the lowest at 0.05. Mortality was generally higher in indigenous than in non-indigenous PD patients. Variations in mortality study results likely reflect differences in the definitions of explanatory variables such as rurality and in the availability of local specialty care services. Technique failure and peritonitis rates were higher among indigenous than among non-indigenous patients. Conclusions The less favorable outcomes in indigenous PD patients across countries may, in part, be a manifestation of reduced access to resources. Understanding the effects of socio-economic, geographic, cultural, and language issues, and of health literacy discrepancies on various aspects of PD education, training, and outcomes can potentially identify ways in which outcomes might be improved among indigenous patients on PD.
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Affiliation(s)
- Suma Prakash
- University of Toronto, Toronto, Ontario, Canada
- Case Western Reserve University, Cleveland, Ohio, USA
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