Dr Andrea Miller1, Dr. Leanne Brown, Dr. Natalie Pink, Kimberley Withers, Dr Murty Mantha1
1Queensland Health, Weipa, Australia
Biography:
Dr. Andrea Miller is a Rural Generalist GP with advanced skills in Adult Internal Medicine (FRACGP/FARGP) with special interest in chronic kidney disease. She has been instrumental in the design and implementation of the award-winning Cape York Kidney care program, a multidisciplinary Specialist Kidney Outreach team that services western Cape York First Nation’s communities. She is an adjunct lecturer and medical educator for James Cook University and the Australian College of Rural and Remote Medicine.
Aim:
The Cape York Kidney Care (CYKC) Service aims to provide holistic, best-practice care for people with chronic kidney disease (CKD) in western Cape York, focusing on delaying CKD progression to dialysis. This research demonstrates a significant reduction in dialysis rates since commencement of the CYKC program.
Background:
CYKC is an integrated, multidisciplinary service delivering care to remote First Nations communities through outreach visits, supported remotely by a tertiary-based Nephrologist. The team includes an Aboriginal and Torres Strait Islander Health Practitioner, a Rural Generalist GP, a Kidney Nurse Practitioner, Dietitian, and Pharmacist. Care is provided via culturally appropriate “yarning-style” consultations that engage the client and their family.
Methods:
A retrospective comparative analysis was conducted to assess rates of dialysis pre and post commencement of CYKC. Pre-service data was sourced from ANZDATA (2016-2019) and compared with the CYKC intervention group (Welches T-test). Rates of planned vs. unplanned starts to dialysis were also assessed.
Results:
Prior to CYKC (2016-2019), 38 individuals started dialysis, compared to only 18 people after the program began (p=0.02). There was no significant difference in unplanned vs. planned dialysis starts (60% vs 55%, respectively).
Conclusions:
People who are accessing the Cape York Kidney Care services appear to be experiencing a lesser need for dialysis. This is likely attributed in part to better opportunities for informed decision making regarding renal replacement therapy (ie supportive care options), as well as early use of best-practice medication for delaying progression of chronic kidney disease. Although this evidence is encouraging, further work is required to determine factors influencing progression to dialysis, including health service engagement.
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