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Effectiveness, cost effectiveness, acceptability and implementation
barriers/enablers of chronic kidney disease management programs for Indigenous
people in Australia, New Zealand and Canada: a systematic review of mixed
evidence
#MMPMID27048280
Reilly R
; Evans K
; Gomersall J
; Gorham G
; Peters MD
; Warren S
; O'Shea R
; Cass A
; Brown A
BMC Health Serv Res
2016[Apr]; 16
(?): 119
PMID27048280
show ga
BACKGROUND: Indigenous peoples in Australia, New Zealand and Canada carry a
greater burden of chronic kidney disease (CKD) than the general populations in
each country, and this burden is predicted to increase. Given the human and
economic cost of dialysis, understanding how to better manage CKD at earlier
stages of disease progression is an important priority for practitioners and
policy-makers. A systematic review of mixed evidence was undertaken to examine
the evidence relating to the effectivness, cost-effectiveness and acceptability
of chronic kidney disease management programs designed for Indigenous people, as
well as barriers and enablers of implementation of such programs. METHODS:
Published and unpublished studies reporting quantitative and qualitative data on
health sector-led management programs and models of care explicitly designed to
manage, slow progression or otherwise improve the lives of Indigenous people with
CKD published between 2000 and 2014 were considered for inclusion. Data on
clinical effectiveness, ability to self-manage, quality of life, acceptability,
cost and cost-benefit, barriers and enablers of implementation were of interest.
Quantitative data was summarized in narrative and tabular form and qualitative
data was synthesized using the Joanna Briggs Institute meta-aggregation approach.
RESULTS: Ten studies were included. Six studies provided evidence of clinical
effectiveness of CKD programs designed for Indigenous people, two provided
evidence of cost and cost-effectiveness of a CKD program, and two provided
qualitative evidence of barriers and enablers of implementation of effective
and/or acceptable CKD management programs. Common features of effective and
acceptable programs were integration within existing services, nurse-led care,
intensive follow-up, provision of culturally-appropriate education, governance
structures supporting community ownership, robust clinical systems supporting
communication and a central role for Indigenous Health Workers. CONCLUSIONS:
Given the human cost of dialysis and the growing population of people living with
CKD, there is an urgent need to draw lessons from the available evidence from
this and other sources, including studies in the broader population, to better
serve this population with programs that address the barriers to receiving
high-quality care and improve quality of life.
|*Health Services, Indigenous/economics
[MESH]
|*Population Groups
[MESH]
|*Primary Health Care/economics
[MESH]
|Australia/epidemiology
[MESH]
|Canada/epidemiology
[MESH]
|Chronic Disease
[MESH]
|Cost-Benefit Analysis
[MESH]
|Disease Management
[MESH]
|Disease Progression
[MESH]
|Health Knowledge, Attitudes, Practice
[MESH]
|Health Promotion
[MESH]
|Health Services Accessibility/economics/*statistics & numerical data
[MESH]
|Humans
[MESH]
|New Zealand/epidemiology
[MESH]
|Patient Acceptance of Health Care/*statistics & numerical data
[MESH]
|Program Development
[MESH]
|Qualitative Research
[MESH]
|Quality of Life
[MESH]
|Renal Dialysis/economics/*statistics & numerical data
[MESH]
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