Chronic kidney disease in an Aboriginal population: A nurse practitioner‐led approach to management

Barrett, Elizabeth; Salem, Lesley; Wilson, Sue; O’Neill, Claire; Davis, Kathleen; Bagnulo, Sharif

doi:10.1111/ajr.12230

Cited by 21 publications

(45 citation statements)

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“…In rural settings, where the limited resources and staffing of non‐rural areas is magnified, effective programmes will likely be multi‐sectoral, multidisciplinary and collaborative (Barrett et al., ; Finke et al., ). Of cases in which palliative care programmes have reported success with Indigenous communities, key factors have been the ability to work closely with a large, interdisciplinary team, close co‐ordination among agencies, and the ability to address complex and/or invisible barriers to care (Fernandes et al., ; McGrath & Phillips, ).…”

Section: Resultsmentioning

confidence: 99%

Priorities and challenges for a palliative approach to care for rural indigenous populations: A scoping review

Schill

Janke

2017

Health Soc Care Community

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We carried out a scoping review to identify key priorities and challenges relevant to rural Indigenous palliative care stated in existing literature. Our scoping review activities followed Arskey and O'Malley's principles for conducting a scoping review. We included peer-reviewed literature from MEDLINE, CINAHL and EMBASE that included a discussion of Indigenous populations, palliative care, and rural settings, and did not use date limits. The literature search was conducted in April 2016, and the retrieved literature was screened for relevance and appropriateness April 2016-March of 2017. In addition to the academic literature, a scan of the grey literature was conducted in March 2017. The retrieved grey literature was screened for relevance and reviewed by a team from a provincial health authority serving Indigenous peoples to ensure relevance in a rural BC setting. Once reviewed for relevance and appropriateness, we added four reports to supplement our analysis. Ultimately, 44 peer-reviewed articles and 4 pieces of grey literature met our inclusion criteria and were included in the review. Our analysis revealed several challenges and priorities relevant to rural Indigenous palliative care. Key challenges included: (i) environmental and contextual issues; (ii) institutional barriers; and (iii) interpersonal dynamics challenging client/clinician interactions. Priorities included: (i) family connections throughout the dying process; (ii) building local capacity for palliative care to provide more relevant and culturally appropriate care; and (iii) flexibility and multi-sectoral partnerships to address the complexity of day-to-day needs for patients/families. These findings point to several areas for change and action that can improve the relevance, access and comprehensiveness of palliative care programming for rural Indigenous communities in Canada and elsewhere. Taking into account of the diversity and unique strengths of each Indigenous community will be vital in developing sustainable and meaningful change.

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Section: Resultsmentioning

confidence: 99%

Priorities and challenges for a palliative approach to care for rural indigenous populations: A scoping review

Schill

Janke

2017

Health Soc Care Community

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“…Inadequate access to early screening and prevention has been noted in low SES populations in the United States 22 ; ethnic minority populations in the United States 23 - 25 ; and in Indigenous populations in Canada and Australia. 5 , 9 , 26 - 28 These populations also experience disparities in access to all renal replacement therapies, as do rural/remote populations, undocumented immigrants, the unemployed, and substance misusers. It has been shown that disadvantaged populations experience reduced access to and worse outcomes from dialysis treatments.…”

Section: Resultsmentioning

confidence: 99%

“…Early screening programs were often mobile and implemented in rural/remote communities, and tended to be successful when developed with community engagement, and education strategies and individualized counseling were included to complement the program activities. 5 - 10 …”

Section: Resultsmentioning

confidence: 99%

Canadian Senior Renal Leaders Community of Practice: Vulnerable Populations With Chronic Kidney Disease—Evidence to Inform Policy

Erdmann

Morrin

Harvey

et al. 2020

Can J Kidney Health Dis

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Purpose: Low socioeconomic status, race, ethnicity, and rural/remote populations are all associated with disparities in access, care, and outcomes for chronic kidney disease (CKD). There have been different interventions supported by Canadian renal programs to address these disparities. This article reviews the evidence for impact of strategies to reduce inequities experienced by vulnerable populations living with or at risk of CKD and to collate and share interprovincial targeted interventions through the newly formed “Canadian Senior Renal Leaders Community of Practice” focused on translating evidence into clinical practice and policy. Source of Information: A literature search of Medline, CINAHL, PubMed, and Google Scholar from 2008 to 2018 identified 13 reports of processes and interventions that have been implemented in Australia, Canada, and the United States to reduce inequities in CKD care and can be categorized into 3 broad areas: (1) early screening and prevention, (2) disease management and dialysis, and (3) pretransplant. Web sites from each Canadian jurisdiction and from Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network were used to assess the current state of Canadian initiatives. Methods: Reviews were completed to gather information on renal initiatives for vulnerable populations, including (1) identification of populations that experience disparities in access to care or in outcomes in the context of CKD prevention and treatment and (2) interventions that have been implemented to reduce disparities in access, care, and outcomes for vulnerable populations with CKD. A current state summary of Canadian initiatives related to vulnerable populations was conducted through a review of publicly available information, including a review of renal program Web sites and a review of current projects related to vulnerable populations that are part of Can-SOLVE CKD. Can-SOLVE CKD is a Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR-SPOR) funded research network to transform the care of people affected by kidney disease. Key Findings: Interventions to improve inequities in access to CKD screening, disease management, and care are successful when developed with community engagement, provided to the patient in their own environment, and tailored to specific populations. Many provincial renal programs have implemented initiatives to support vulnerable populations with or at risk of CKD. Current projects funded through CIHR SPOR focus on underserved populations and involve partnerships with Indigenous populations. Many renal programs in Canada had or were in the process of implementing interventions to support vulnerable populations with CKD; however, information about the initiatives were not readily available online despite a strong interest and opportunity to support interprovincial knowledge sharing. Despite this common interest, little information is systematically shared between Canadian jurisdictions to support interprovincial sharing to promote evidence-informed policy and program development. Efforts will be made through the newly formed Canadian Senior Renal Leaders Community of Practice to collaborate and share learnings to inform future program and policy development, implementation, and evaluation. Limitations: As this was not a systematic review, literature search only encompassed studies published in English between 2008 and 2018. It is possible that populations and interventions were overlooked during the search and through the screening process. Furthermore, the controversial definition of “vulnerable” and literature that only came from Canada, the United States, and Australia limits the generalizability of this review.

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“…Specialist consultation was often led in the community by non-MD health professionals. 12-18 These clinics may have also included home visits, 17 transportation of patients to pharmacy and lab, 13 or counseling about lifestyle choices. 14-17…”

Section: Resultsmentioning

confidence: 99%

Interventions to Improve Clinical Outcomes in Indigenous or Remote Patients With Chronic Kidney Disease: A Scoping Review

Ovtcharenko

Thomson

2019

Can J Kidney Health Dis

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Background:Chronic kidney disease (CKD) associates with a significant health care burden with a disproportionate impact on indigenous persons or people living in remote areas. Although screening programs have expanded in these communities, there remains a paucity of evidence-based interventions to enhance clinical renal outcomes in these populations.Objective:The objective of this study was to identify evidence-based interventions to enhance renal outcomes in these populations.Design:A scoping review was conducted for studies in the Cochrane, MEDLINE, and Embase databases and from major nephrology meetings.Setting:Chronic kidney disease, including those on dialysis.Patients:Remote or indigenous populationsMeasurements:Studies that performed an intervention that was followed by measurement of renal outcomes or patient-centered outcomes (ie, quality of life) were included.Methods:All studies were described by study type, intervention, and clinical outcome, and trends were identified by both authors. Meta-analysis was not conducted due to study heterogeneity.Results:Thirty-two studies met inclusion criteria, only 2 (6.3%) of which were randomized controlled trials. Intervention types included multidisciplinary (34.4%), satellite (32.3%), telehealth (25.0%), or other (9.4%). All multidisciplinary interventions were performed in the CKD (non-dialysis) setting and reported improved patient travel time, waiting time, quality of life, kidney function, proteinuria, and blood pressure. Telehealth interventions improved program cost, patient attendance, hospitalization, and quality of life. Satellite interventions were performed in the hemodialysis setting, with 1 study evaluating acute hemodialysis. Satellite interventions improved patient travel time, dialysis clearance, quality of life, and survival, but increased program costs.Limitations:The study was restricted to interventional trials assessing clinical outcomes and to studies in developed countries, which likely excluded some research contributing to this field.Conclusions:There is significant heterogeneity among studies of interventions for patients with CKD who are indigenous or live remotely. Interventions were more likely to be successful when the remote or indigenous community was included in program development, with a culturally safe approach. More large, high-quality studies are needed to identify effective interventions to enhance clinical renal outcomes in indigenous or remote populations.Trial Registration:This trial is registered under PROSPERO, Registration Number 128453.

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Chronic kidney disease in an Aboriginal population: A nurse practitioner‐led approach to management

Abstract: The need for strong multi-disciplinary teamwork has been demonstrated with good communication strategies implemented.

Cited by 21 publications

References 0 publications

Priorities and challenges for a palliative approach to care for rural indigenous populations: A scoping review

Priorities and challenges for a palliative approach to care for rural indigenous populations: A scoping review

Canadian Senior Renal Leaders Community of Practice: Vulnerable Populations With Chronic Kidney Disease—Evidence to Inform Policy

Interventions to Improve Clinical Outcomes in Indigenous or Remote Patients With Chronic Kidney Disease: A Scoping Review

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