Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man.
CMAJ. 2021 Jul 19;193(28):E1076-E1084. doi: 10.1503/cmaj.201731.
In 2013-2015, we conducted point-of-care screening for hypertension, diabetes and chronic kidney disease in rural and remote Indigenous communities in Manitoba, Canada. In this study, we aimed to determine whether optimal follow-up care was provided, defined as proportion of individuals with appropriate kidney disease laboratory testing, medication prescriptions and physician visits.
We linked screening data from participants to provincial administrative data sets to evaluate whether frequencies of laboratory testing, prescriptions of disease-modifying medications, and primary care and nephrology visits differed in the 18 months before and after screening. We also conducted a propensity score matching analysis to compare outcomes between screened and unscreened adults.
Of 1353 adults who received the screening intervention and who had complete administrative data available, 44% were at risk of kidney failure at screening. Among these individuals, frequencies of comprehensive laboratory testing (estimated glomerular filtration rate and urine albumin to creatinine ratio) improved by 17.0% (95% confidence interval [CI] 11.5 to 22.5), anti-hyperglycemic medications improved by 4.4% (95% CI 1.0 to 7.8), and nephrology visits for participants meeting referral criteria improved by 5.9% (95% CI 3.4 to 8.5). We observed significant improvements in laboratory testing, antihyperglycemic medications and nephrology visits in the screened group compared with the 1:1 matched comparison group.
Point-of-care screening programs in rural and remote Indigenous communities are adaptable methods for increasing awareness, monitoring risk and treating chronic diseases. Interventions such as the development of a national screening program could improve chronic disease care in high-risk populations.
2013-2015 年，我们在加拿大马尼托巴省的农村和偏远地区的土著社区进行了即时护理高血压、糖尿病和慢性肾脏病的筛查。在这项研究中，我们旨在确定是否提供了最佳的后续护理，其定义为有适当的肾脏病实验室检测、药物处方和医生就诊的个体比例。
我们将参与者的筛查数据与省级行政数据集相联系，以评估在筛查前后 18 个月内，实验室检测、疾病修正药物的处方、初级保健和肾病学就诊的频率是否有所不同。我们还进行了倾向评分匹配分析，以比较筛查和未筛查成年人的结果。
在接受了筛查干预且有完整行政数据的 1353 名成年人中，44%在筛查时处于肾衰竭风险中。在这些人中，全面实验室检测（估计肾小球滤过率和尿白蛋白与肌酐比值）的频率增加了 17.0%（95%置信区间 11.5 至 22.5），抗高血糖药物增加了 4.4%（95%置信区间 1.0 至 7.8），符合转诊标准的参与者的肾病学就诊增加了 5.9%（95%置信区间 3.4 至 8.5）。与 1:1 匹配的对照组相比，我们在筛查组中观察到实验室检测、抗高血糖药物和肾病学就诊的显著改善。
农村和偏远地区的土著社区的即时护理筛查计划是提高认识、监测风险和治疗慢性病的可适应方法。像开发国家筛查计划这样的干预措施可以改善高危人群的慢性病护理。
