Supporting equitable access to kidney transplant in remote Western Australia using continuous quality improvement.

IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Felicity Stewart, Nicholas Corsair, James Stacey, Sarah Cox, Joshua Bowring, Khalil Patankar, Iann Lee, Kristan Teasdale, Emma Griffiths
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引用次数: 0

Abstract

Background: Despite an epidemic of End-Stage Kidney Disease in the Australian Aboriginal and Torres Strait Islander population, disparities in access to kidney transplantation persist. The journey to successful kidney transplant is long, with an initial suitability assessment required before waitlist-specific activities begin. In an Aboriginal Community Controlled renal service, we aimed to: 1.) Design and implement a continuous quality improvement (CQI) approach to transplant suitability assessment2.) Provide transplant suitability assessments for all patients of the service3.) Describe what temporary contraindications to kidney transplantation should be the focus of health service improvements4.) Explore participant experiences with the suitability assessment process and:5.) Use our findings to inform pre-and post-transplant model of care development within Kimberley Renal Services.

Methods: Mixed methods design with file review. Transplant suitability assessment results with descriptive analysis, semi-structured interview with thematic analysis.

Results: Of completed assessments, 20/66 (30%) had no contraindications and were cleared for workup with median time on dialysis prior to assessment of 2.9 years, 42/66 (64%) had temporary contraindications, and 4/66 (6%) had permanent contraindications. Eighty-five temporary contraindications were identified in 46 individuals: 17/46 had both medical and non-medical contraindications, 5/46 had medical contraindications only, and 24/46 had non-medical contraindications only. The most common temporary contraindications were smoking (23/46), treatment adherence (17/46) and high body mass index (BMI) (11/46). Patients wanted more information on the transplant process, and interviewers noted the importance of providing information in an appropriate way. Patients wanted more support to address modifiable health risk factors to improve their chances of future transplantation.

Conclusions: In the first stages of our CQI approach to improving access to kidney transplants for Kimberley Aboriginal people we achieved substantial catch-up in suitability assessments, and a comprehensive summary of factors impacting successful waitlisting. Our results are consistent with, and build upon other work in this space, highlighting the importance of involving Aboriginal staff and patients in education and support for prospective recipients.

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来源期刊
CiteScore
4.90
自引率
3.80%
发文量
87
审稿时长
6-12 weeks
期刊介绍: The International Journal for Quality in Health Care makes activities and research related to quality and safety in health care available to a worldwide readership. The Journal publishes papers in all disciplines related to the quality and safety of health care, including health services research, health care evaluation, technology assessment, health economics, utilization review, cost containment, and nursing care research, as well as clinical research related to quality of care. This peer-reviewed journal is truly interdisciplinary and includes contributions from representatives of all health professions such as doctors, nurses, quality assurance professionals, managers, politicians, social workers, and therapists, as well as researchers from health-related backgrounds.
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