HOW DO WE KNOW IF WE DO NOT SCREEN? THE TE TAI TOKERAU EARLY CKD PROGRAMME
Walaa Saweirs1, Tracey Saweirs1, Rian Gale1 1Te Whatu Ora Te Tai Tokerau, Whangarei, Northland, New Zealand
Abstract
Aim:
To increase the uptake of uACR testing to at least 50%.
Background:
KDIGO defined CKD such that an elevated urinary ACR identifies early stages of CKD. An elevated uACR is a strong and independent CVD risk factor. Early detection of CKD can reduce its burden and attendant complications. This is particularly relevant in high-risk populations e.g. Māori and Pasifika. The ’Kidney Health Check’ (blood pressure, eGFR and uACR) should be performed every 1-2 years in those ‘at risk’ of CKD. The recent Deloitte-KHA report highlights the economic value of early detection with a net benefit of $45AUD for every $1AUD invested.
Methods:
The programme utilises a co-design approach as part of a multi-pronged intervention. Four primary care teams (2 active and 2 control) are participating in a ‘uACR nudge’ trial, in conjunction with mentoring support that commenced in March 2023. The reScript® software screens patients to identify those ‘at risk’. If a uACR has not been performed in >15 months a ‘nudge’ appears on the clinician’s work page (Recommend kidney health check: Please consider urine ACR) at the time a prescription is written.
Results:
Baseline data from the reScript® Health Network of primary care systems in rural Northland revealed that 47% of the population falls within the ‘at risk’ category. Of these, 82% have not had a check of their uACR within the previous 15 months and only 35% have had a check of their eGFR within the same period. Within the first month of the trial, 423 consults were ‘nudged’ and 32 uACRs were completed.
Conclusions:
There are potential areas for refinement of the ‘nudge’ process and a need for additional educational input.
Biography
Trained in Edinburgh and completed a PhD on MHC Class II tetramer formation. I was part of the Scottish Intercollegiate Guidelines Network that helped develop guidelines on early CKD, and was a contributor to the 2014 New Zealand National Consensus Statement on the management of CKD.
I helped establish a telehealth program in Northland incorporating multi-disciplinary links with the tertiary centre and within the renal unit. I established a monthly clinical meeting with primary care teams in the “Far North”.
Currently, a full-time Nephrologist, lead clinician for Peritoneal Dialysis, and past Chair of the New Zealand Peritoneal Dialysis Registry.