Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), 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 (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man.
CMAJ. 2021 Sep 13;193(36):E1415-E1422. doi: 10.1503/cmaj.210507.
The First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis project was a point-of-care screening program in rural and remote First Nations communities in Manitoba that aimed to identify and treat hypertension, diabetes and chronic kidney disease. The program identified chronic disease in 20% of children screened. We aimed to characterize clinical screening practices before and after intervention in children aged 10-17 years old and compare outcomes with those who did not receive the intervention.
This observational, prospective cohort study started with community engagement and followed the principles of ownership, control, access and possession (OCAP). We linked participant data to administrative data at the Manitoba Centre for Health Policy to assess rates of primary care and nephrology visits, disease-modifying medication prescriptions and laboratory testing (i.e., glycosylated hemoglobin [HbA], estimated glomerural filtration rate [eGFR] and urine albumin- or protein-to-creatinine ratio). We analyzed the differences in proportions in the 18 months before and after the intervention. We also conducted a 1:2 propensity score matching analysis to compare outcomes of children who were screened with those who were not.
We included 324 of 353 children from the screening program (43.8% male; median age 12.3 yr) in this study. After the intervention, laboratory testing increased by 5.8% (95% confidence interval [CI] 1.1% to 10.1%) for HbA, by 9.9% (95% CI 4.2% to 15.5%) for eGFR and by 6.2% (95% CI 2.3% to 10.0%) for the urine albumin- or protein-to-creatinine ratio. We observed significant improvements in laboratory testing in screened patients in the group who were part of the program, compared with matched controls.
Chronic disease surveillance and care increased significantly in children after the implementation of a point-of-care screening program in rural and remote First Nation communities. Interventions such as active surveillance programs have the potential to improve the chronic disease care being provided to First Nations children.
第一民族社区为改善肾脏健康和预防透析而进行的基于社区的筛查项目是曼尼托巴省农村和偏远地区第一民族社区的一项即时护理筛查计划，旨在发现和治疗高血压、糖尿病和慢性肾脏病。该计划在接受筛查的儿童中发现了 20%的慢性疾病。我们的目的是描述 10-17 岁儿童在干预前后的临床筛查实践，并将结果与未接受干预的儿童进行比较。
这项观察性、前瞻性队列研究始于社区参与，并遵循所有权、控制、访问和占有原则（OCAP）。我们将参与者的数据与曼尼托巴省卫生政策中心的行政数据联系起来，以评估初级保健和肾病学就诊、疾病修正药物处方和实验室检测（即糖化血红蛋白[HbA]、估算肾小球滤过率[eGFR]和尿白蛋白或蛋白与肌酐的比值）的比率。我们分析了干预前后 18 个月内比例的差异。我们还进行了 1:2 的倾向评分匹配分析，以比较接受和未接受筛查的儿童的结果。
我们将筛查计划中的 353 名儿童中的 324 名（43.8%为男性；中位年龄 12.3 岁）纳入了这项研究。干预后，HbA 的实验室检测增加了 5.8%（95%置信区间[CI]为 1.1%至 10.1%），eGFR 增加了 9.9%（95%CI 为 4.2%至 15.5%），尿白蛋白或蛋白与肌酐的比值增加了 6.2%（95%CI 为 2.3%至 10.0%）。我们观察到，在参与该计划的筛查患者中，实验室检测显著改善，与匹配的对照组相比。
在农村和偏远的第一民族社区实施即时护理筛查计划后，儿童的慢性疾病监测和护理显著增加。主动监测等干预措施有可能改善为第一民族儿童提供的慢性疾病护理。
