June 2015 |
Manitoba Renal Program and Diabetes Integration Project are excited to share outcomes from their two-year FINISHED project that launched in 2013. FINISHED (First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis) adapted DIP’s established model of care for diabetes screening and provided on-site screening and results sharing for 11 communities within two tribal council regions and screened over 1,700 community members.
Kidney disease screening that targeted at-risk populations through a collaborative effort of First Nations communities and governance, provincial and federal governments, and provincial and Indigenous health organizations had never occurred in Manitoba.
“This project has had many achievements including providing access to care, ensuring follow up care to those identified through the project and developing meaningful, collaborative relationships between stakeholders,” said Dr. Catherine Cook, Vice-President of Population and Aboriginal Health with Winnipeg Regional Health Authority.
Four communities screened were remote (accessible only by air a majority of the year), while seven were accessible by road. A mean screening rate of 21% of all community member eligible (aged 10 – 80) was achieved. Over a quarter of participants had some level of kidney disease.
All patients deemed intermediate or high risk of kidney failure in both pediatric and adult populations received nephrology referrals and were seen by a nephrologist in Winnipeg within one month of screening. This had no adverse effects on lengthening wait times for pediatric or adult nephrology clinics.
The mean screening rate in the remote communities was 12% while the other communities accessible by road achieved screening rates of 25.7%.
Detailed community engagement processes were developed in order to ensure a collaborative and respectful approach to community screening. Project leaders, including nephrologists, connected with community governance and members to share information and seek permission and guidance for delivering screening in their respective community.
Point of care screening utilized innovative technology, including a secure custom-developed application, to input and deliver risk assessments (no risk, low risk, intermediate risk and high risk) based on the Kidney Failure Risk Equation (KFRE) for adults.
For pediatric patients (under age 18), a new risk-assessment algorithm was designed for the project in collaboration with pediatric nephrologist and endocrinologist partners.
An adapted model of the project has been implemented in Winnipeg by NorWest Co-op Community Health Centre with support from FINISHED. Other provincial programs have engaged the project team and expressed interest in utilizing the project model.
“Overall we are pleased with the outcomes of the project,” say Dr. Mauro Verrelli, Medical Director for Manitoba Renal Program. “We now have a baseline on which we can only expand and improve upon in order to reduce the rates of dialysis and end stage kidney disease in Manitoba.”
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