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

Abstract

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.

Telehealth strategies in the care of people with chronic kidney disease: integrative review

“…The complexity of the therapy and its risks demand from the patient a greater capacity for self-care and interaction with the health team, which is allowed by the use of communication technologies ( 5 ) . Moreover, a potential benefit of telehealth in Nephrology is the greater acceptance of home therapies where, despite the distance, access to professionals by the patient would be optimized ( 4 ) .…”

“…In this review, the comparability on the effectiveness between the various tools was not possible due to the diversity of methodological designs in the included studies, as well as the population studied and the outcomes evaluated by the study, the particularities pointed out in other publications ( 3 - 4 ) . As limitations, we can mention the possibility of selection bias, which was controlled by the number of reviewers who selected the articles independently, the impossibility of access to the full text of four articles after exhausting the attempts, the absence of some data on the professional involved in the research, which did not prevent the possibility of characterization of the evidence listed.…”

“…In this sense, Telehealth (TH), which covers the most diverse categories of remote care, presents itself as a viable and safe strategy to support the needs of chronic kidney patients ( 4 - 5 ) . TH involves providing and promoting long-distance clinical care, health education for patients and professionals, public health, and health administration ( 5 - 6 ) .…”

The impact of community-based non-pharmacological interventions on cardiovascular and kidney disease outcomes in remote dwelling Indigenous communities: A scoping review protocol

“…A recent scoping review assessed interventions to improve clinical outcomes in Indigenous or remote patients with CKD with a primary objective of identifying evidence-based interventions in such populations [29]. They identified 32 studies that included multidisciplinary (34.4%), satellite (32.3%), telehealth (25.0%), or other (9.4%) interventional types and reported that interventions were more likely to be successful when the remote or Indigenous community was included in program development, with a culturally safe approach [29].…”

“…A recent scoping review assessed interventions to improve clinical outcomes in Indigenous or remote patients with CKD with a primary objective of identifying evidence-based interventions in such populations [29]. They identified 32 studies that included multidisciplinary (34.4%), satellite (32.3%), telehealth (25.0%), or other (9.4%) interventional types and reported that interventions were more likely to be successful when the remote or Indigenous community was included in program development, with a culturally safe approach [29]. Also, an Australian study that assessed how effective cardiovascular programs were for Indigenous Australians found that the common features of effectiveness of programs were integration of programs within existing services, provision of culturally appropriate delivery models with a central role for Indigenous health workers, and provision of support processes for communities such as transportation [14].…”