Torres and Cape Hospital and Health Service, PO Box 341, Weipa, QLD, Australia.
Murtupuni Centre for Rural and Remote Health, & Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia.
BMC Health Serv Res. 2023 Aug 24;23(1):907. doi: 10.1186/s12913-023-09887-6.
Chronic Kidney disease (CKD) is over-represented amongst First Nation people with more than triple the rate of CKD in those aged 15 years and over. The impact of colonisation, including harmful experiences of health practices and research, has contributed to these health inequities. Cape York Kidney Care (CYKC) has been created as an unique service which provides specialist care that aims to centre the client within a multidisciplinary team that is integrated within the primary care setting of the remote health clinics in six communities in western Cape York, Australia. This research aims to describe the Cape York Kidney Care service delivery model, and baseline service data, including aggregated client health measures.
The model of care is described in detail. Review of the first 12 months of service provision has been undertaken with client demographic and clinical profile baseline data collected including kidney health measures. Participants are adults (> 18 years if age) with CKD grades 1-5. This data has been de-identified and aggregated.
CYKC reviewed 204 individuals, with 182 not previously been reviewed by specialist kidney health services. Three quarters of clients identified as Aboriginal. The average age was 55 with a high level of comorbidity, with majority having a history of hypertension and Type 2 diabetes (average Hba1c 8.2%). Just under one third had cardiovascular disease. A large proportion of people had either Grade 2 CKD (32%) or Grade 3 CKD (~ 30%), and over half had severely increased albuminuria (A3), with Type 2 diabetes being the predominant presumed cause of CKD. Most clients did not meet evidence-based targets for diabetes, blood pressure or lipids and half were self-reported smokers. The proportion of clients reviewed represents 6.2% of the adult population in the participating First Nation communities.
The CYKC model was able to target those clients at high risk of progression and increase the number of people with chronic kidney disease reviewed by specialist kidney services within community. Baseline data demonstrated a high burden of chronic disease that subsequently will increase risk of CKD progression and cardiovascular disease. People were seen to have more severe disease at younger ages, with a substantial number demonstrating risk factors for rapid progression of kidney disease including poorly controlled Type 2 diabetes and severely increased albuminuria. Further evaluation concerning implementation challenges, consumer and community satisfaction, and health outcomes is required.
慢性肾脏病（CKD）在原住民中更为普遍，15 岁及以上人群的 CKD 发病率是其他人群的三倍多。殖民化的影响，包括对健康实践和研究的有害经历，导致了这些健康不平等。约克角肾脏护理（CYKC）是一种独特的服务，提供专业护理，旨在将客户置于一个多学科团队的中心，该团队整合在澳大利亚西部约克角六个社区的远程医疗诊所的初级保健环境中。这项研究旨在描述约克角肾脏护理服务提供模式和基线服务数据，包括汇总的客户健康指标。
详细描述了护理模式。对服务提供的头 12 个月进行了审查，收集了包括肾脏健康指标在内的客户人口统计学和临床概况基线数据。参与者为成年人（年龄>18 岁），CKD 分级 1-5 级。这些数据已被去识别并汇总。
CYKC 共审查了 204 人，其中 182 人以前未接受过专科肾脏健康服务的审查。四分之三的客户被认定为原住民。平均年龄为 55 岁，合并症发生率较高，大多数有高血压和 2 型糖尿病病史（平均 Hba1c 8.2%）。近三分之一的人患有心血管疾病。相当一部分人患有 2 级 CKD（32%）或 3 级 CKD（~30%），超过一半的人有严重的白蛋白尿（A3），2 型糖尿病是 CKD 的主要推测原因。大多数患者不符合糖尿病、血压或血脂的循证目标，有一半人报告吸烟。接受审查的患者比例占参与原住民社区的成年人口的 6.2%。
CYKC 模式能够针对那些有进展风险的高危人群，并增加社区内接受专科肾脏服务审查的慢性肾脏病患者数量。基线数据显示，慢性病负担沉重，随后将增加 CKD 进展和心血管疾病的风险。人们在较年轻时就出现更严重的疾病，大量患者存在快速进展性肾病的危险因素，包括 2 型糖尿病控制不佳和严重增加的白蛋白尿。需要进一步评估实施挑战、消费者和社区满意度以及健康结果。
