Kidney Disease In Australia

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Kidney disease is a significant health issue globally and is considered by many a disease of disadvantage 1-3. In Australia there is a steep gradient in the burden of kidney disease from urban to remote areas with people in remote areas suffering much higher levels of disease 4. Indigenous Australians are more likely to be affected by kidney disease 5. Nationally Indigenous Australians make up 2% of the population, although in the Northern Territory (NT) they comprise 30% of the population with the majority (70%) living in remote and very remote areas 6. Kidney disease is particularly prevalent amongst Indigenous Territorians, who have the highest incidence and prevalence of kidney disease in Australia 7.
End stage kidney disease (ESKD) refers
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Acceptance of treatment is influenced by the impact a treatment model has on a patient’s quality of life 24 25. Thus a patient’s preference for a model of care can affect treatment uptake and adherence and impact on health outcomes 26. As requirements for dialysis extends over many years, models of dialysis care must be sustainable, cost-effective and appropriate for the patient group and setting. Our aim is to investigate the costs and outcomes relevant to each of five selected dialysis models of care in the NT.
This paper describes the protocol for a study to evaluate the health, social and financial impact of different dialysis models of care on patients and families, health and other government services.
Dialysis Models of Care (MoC) in the Northern Territory
NT Renal services are configured in a hub and spoke arrangement with the hubs (two tertiary hospitals) providing program oversight and specialised care. The hubs are linked to a network of dialysis facilities (spokes) in other urban and regional locations. The arrangement includes government as well as publicly funded non-government services. Patients are clients of both services.
The spokes comprise five principal dialysis models of care (MoC) (Table 1). Hub services are excluded. Patients move between MoC according to choice, their level of clinical stability and physical mobility and facility capacity.
Table 1: Principal Models of Dialysis Care in
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All patients commence treatment here, default service when other models at capacity.
Model 2
Regional Satellite Unit Smaller distant facilities, often co-located with regional hospitals to access support services. Offers haemodialysis and some support for self-care patients in local community Accepts stable, adherent patients: usually a waiting list.
Model 3
Rural/remote Satellite Unit Small unit distant from hub service, may co-locate with local primary health clinic to access services. Offers haemodialysis and some support for self-care therapies; Accepts adherent, stable, physically mobile patients.
Model
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