Aboriginal Renal Disease Prevention and Education Program

Hunter New England Area Health Service

This project was entered in the Baxter 2006 NSW Health Awards, Access to Services category

Contact: Sally Bristow

Abstract

Indigenous people represent 7.1% of the population living in the Northern sector of HNE and currently comprise 31% of the total haemodialysis patients in this area. The Northern Renal Sector of HNE identified a need for an Indigenous culturally appropriate service to address the increase of renal failure amongst this group, developing a Renal Aboriginal Health Education Officer (AHEO) position to work within the multidisciplinary renal team. In May 2004 an AHEO was employed.  After consultation it was agreed that the main focus of the AHEO's position would be prevention. This involved the development of a renal screening program including urinalysis, Blood Pressure and Blood Glucose testing and a culturally appropriate Renal Education Program by the AHEO and the Renal Nurse Educator.

Aim

To provide a community based coordinated and culturally appropriate prevention and screening, program that identifies risk factors that lead to kidney disease, ensuring that appropriate information and referrals are provided to 100% of the Aboriginal people participating.

Background

The New England Area Health Service Aboriginal Health Strategic plan (2005), the now Northern sector of HNE health has the largest number of Aborigines of any Area Health Service.  Surveys conducted on the Aboriginal population in this area found the same levels of lifestyle and co morbidity risk factors as identified in the NSW health Aboriginal Health Strategic Plan, such as, Diabetes, Cardiovascular disease, High blood pressure, poor diet and nutrition and obesity.  These risk factors contribute to the incidence of kidney disease among Aboriginal communities, which is four to six times that of the non-indigenous Australian population. Over the last 20 years the prevalence of kidney disease has doubled every 4-5 years in the Aboriginal community indicating the need to provide a service to address these issues.

Method

After extensive consultation with the Public Health Unit, the Renal Team and Aboriginal Health, a Renal Aboriginal Health Education Officer position was developed and recruited to full time in May 2004.   This inaugural position was a first for NSW Health to be specifically employed in a renal specialty and to take on a proactive role in the prevention of kidney disease.   The aim is to reduce the amount of indigenous patients needing dialysis.  

Table 1: Patients on dialysis in the Northern Sector
 

Source: Patient Audit February 2006

For the first six months of employment the AHEO carried out extensive research into kidney disease and its relationship to the indigenous population.  This was done through literature reviews, internet searches, ringing, meeting and speaking with various health professionals with an interest in kidney disease and working collaboratively with the national and state bodies that steer both Indigenous health and kidney health. From this a collection of resources was gathered mostly from:

• Kidney Health Australia
• Hunter New England Health Hunter Renal Resource Centre
• NSW DOH Aboriginal Vascular health program
• NSW DOH ? check your Kidneys manual

The AHEO realized the need for a community based and culturally appropriate education program for the prevention of kidney disease. A wide search for educational resources revealed a lack of renal resources appropriate for the indigenous community, necessitating the development of a program that could be delivered, to both the community and aboriginal health workers that was suitable to local needs. This education program was developed with consultation from many stakeholders including indigenous community groups, renal clinicians, Kidney Health Australia, community health practitioners and Aboriginal Health.  The program targets the Indigenous population who are all at high risk of kidney disease.

In conjunction with the education program was the rollout of a screening program for kidney disease.  The screening program provided many challenges, as existing screening programs did not include a renal component and there was a risk of over screening the Indigenous population.  This highlighted the need for renal education in the indigenous community and amongst Aboriginal Health professionals.  The aim was to provide a collaborative approach to screening across the area with Aboriginal health, Aboriginal Medical Centres, renal clinicians and primary health care nurses.

Promotion of the AHEO position and role within the community was essential for the success of screening and rolling out the education program. It was important for communication to be provided in a way that was easy to understand and culturally appropriate. This approach has been extremely valuable in promoting the Aboriginal Kidney Disease Prevention and Education Program.  Other communication strategies have included; media support through newspapers, local radio, flyers, and brochures; attending multiple meetings with Local Lands Council, Aboriginal Medical Services, Community Development Employment Program and community health.

Planning and Implementation

The Aboriginal renal screening program was rolled out over two pilot sites; Wee Waa and Moree.  Education to the health services, primary community nurses and Aboriginal health workers at these sites was provided prior to the rolling out of screening.  The screening involved:

• Written consent
• Physiological assessment - Blood pressure, Urinalysis (Microalbuminuria), Blood glucose testing
• Healthy Lifestyle and  kidney disease education
• Medical history
• Family history
• Demographics
• Referral to GP if positive with any adverse findings

An education program was developed and is run in the form of a workshop. To this stage, we have run over fifteen workshops to a broad range of communities. Education covers subjects such as

• what is the kidney and what does it do,
• common kidney problems
• risk factors
• healthy lifestyle
• prevention and screening
• what to do if you have a kidney problem

The results of the screening program to date are as follows:

Table Two: Physiological Abnormalities detected

Source: Renal Screens - AHEO Data Collection, May 2006

Table Three: Family History

Source: Renal Screens - AHEO Data Collection, May 2006

Table Four: Smoking

Source: Renal Screens - AHEO Data Collection, May 2006

Outcomes and Evaluation

Of all the patients screened 24% have been referred to their GP with a further 33% already receiving medical treatment.  Annually incentre haemodialysis cost $50, 000; by preventing or delaying the onset of end stage renal failure for one person is saving health care dollars and improving health outcomes for individuals.

Table Five: Referral Rate to GP

Source: Renal Screens - AHEO Data Collection, May 2006

Aboriginal Kidney Disease Prevention and Education Program has identified the need for a more coordinated and cultural approach to the prevention of, and screening for kidney disease in the indigenous community. It has also identified the need for more indigenous people to be employed to roll out similar programs suited to their local area.

Education for Aboriginal Health Workers is the key to increasing their knowledge and skills in kidney disease this will in turn enable them to provide, early detection, referral, management and ongoing assessment of kidney disease and could lead to better health outcomes.

The renal AHEO is part of the renal team.  Contributing cultural appropriate service delivery at an on operational and strategic level and also assisting in clinical case management of Aboriginal patients as needed.  This has been valuable in ensuring that service delivery is assessable, appropriate and meets the needs of the local Aboriginal communities.

Future Scope

Dialysis is a very resource consuming health resource and the only way to reduce the incidence of dialysis dependent people is to detect and treat kidney disease early and prolong kidney function.

Kidney Health Australia has recommended nationally that we take a more proactive role in preventing kidney failure within our communities particularly since one in three Australians are at an increased risk of developing kidney disease.  Through our Aboriginal Kidney Disease Prevention and Education Program we are providing a way to slow the rate of people coming onto dialysis by recognising and better managing kidney disease.  All renal services can adapt this program to meet the needs of their local communities.