422R - Research Paper

Abstract
Aim:
To identify recent interventions to improve kidney health equity that focus on social determinants of health.

Method:
A narrative literature review of PUBMED, MEDLINE and Scopus for interventions published in English between 2021-2023 which sought to improve kidney health equity using approaches that specifically addressed social determinants of health. After screening, 19 studies were included. Data were extracted and collated using content analysis.

Results:
Important sources of inequity identified were race/ethnicity, gender, healthcare access and environmental contamination. We identified five levels of care at which kidney health equity interventions could be targeted: 1) patients, families, and caregivers; 2) healthcare teams; 3) health systems; 4) communities; and 5) health policy. Across these levels, approaches were classified into peer support, education, nutrition, financial, workforce, technology, data coding, community engagement, clinical guidelines, policy, and research interventions. Examples of these included culturally-tailored exercise/diet plans, antiracist health curricula, and a research scorecard to improve representation of minority communities.

Conclusion:
The engagement of diverse patients, families, caregivers and communities in healthcare research and implementation, as well as clinical care delivery, is vital to counteracting the deleterious effects of social determinants of kidney health.

510Q - Research Paper

Abstract
Aim:
To improve workforce and service delivery models in an attempt to streamline kidney care and reduce travel for rural patients

Method:
Traditionally patients would need to come to tertiary centres for renal specialist care. We redesigned this pathway through a number of initiatives starting with agreements with rural health services. We have 3 nurses training, educating and clinically supporting satellite staff and patients. Additionally, 6 Nurse Practitioners compliment care in the regional setting. Rural home dialysis patients are trained and managed by 3 ‘Link’ nurses and 4 Dialysis Service technicians. We established outpatient clinics in larger regional cities and our team travel to sites, to support clinics, supplemented by telehealth. Our in-house proprietary electronic medical records reports data on all rural patients, with tailored algorithms and audit tools. We work closely with our rural partners on capability frameworks, patient flow and emergency plans.

Results:
The objective of this initiative achieved its primary goal of providing rural patients with specialist renal health care. The uptake of services from clinics, education and links to tertiary renal specialist centre exceeded expected growth throughout the region. With many centres and clinics fully utilised, there is an been ongoing development of services with rural partners to meet increasing needs. 

Conclusion:
These service changes resulted in streamlined referrals, transfers and efficiencies in kidney care management. Local and telehealth consultations have allowed patients to remain in their communities and dramatically reduce the cost of travel and angst for patients undergoing an already burdensome treatment 

406C - Research Paper

Abstract
Case Description:
The case follows the journey of an Aboriginal person in regional Australia and his acute start to dialysis and the challenges faced due to his complex situation, dealing with various agencies, and social complexities.

Discussion:
Following the journey of the patient, it became apparent there was a lack of understanding of the dialysis commencement process when multiple agencies become involved. The complexities of someone for whom English is a second language and the large distances patients need to travel in regional areas. The large distances are also impacted by limited public transport as well as the expense of travel in regional areas, often with limited return benefits. Importantly there is also discussion on how many remain displaced from where they call home as a result of requiring dialysis treatment.

Conclusion:
The case study reviews the distance travelled by dialysis patients when starting their dialysis journey and how this could be improved by combining multiple treatments required when patients are having to attend metropolitan centres for treatment. This became especially important during the covid pandemic when public transport options became limited as well as access to Aboriginal Communities. Through the study it was also noted that ANZDATA do not record those who have had to remain displaced as a result of requiring dialysis treatment and the importance of including this information to get accurate data on where the need for treatment is and monitor the ongoing distance patients need to travel. 

The Australian Government Department of Health and Aged Care has prioritised partnership and community to guide the implementation of a $45 million commitment to build up to 30 four-chair dialysis units in remote First Nations communities. By putting the Priority Reforms of the National Agreement on Closing the Gap at the centre, this project highlights that governments can do things differently and in genuine partnership to improve health outcomes for First Nations people.