Impact of point-of-care screening for hypertension, diabetes and progression of chronic kidney disease in rural Manitoba Indigenous communities
| Autor: | Claudio Rigatto, Paul Komenda, Lorraine McLeod, Thomas W. Ferguson, Barry Lavallee, Caroline Chartrand, Navdeep Tangri, Oksana Harasemiw, Allison Dart |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Rural Population Nephrology medicine.medical_specialty Referral Point-of-Care Systems Psychological intervention Renal function Diabetes mellitus Internal medicine Diabetes Mellitus medicine Humans Mass Screening Indigenous Canadians Renal Insufficiency Chronic Medical prescription business.industry Research Manitoba General Medicine Health Services medicine.disease Hypertension Propensity score matching Emergency medicine Disease Progression business Kidney disease |
| Zdroj: | CMAJ : Canadian Medical Association Journal |
| ISSN: | 1488-2329 0820-3946 |
| DOI: | 10.1503/cmaj.201731 |
| Popis: | BACKGROUND: In 2013–2015, we conducted point-of-care screening for hypertension, diabetes and chronic kidney disease in rural and remote Indigenous communities in Manitoba, Canada. In this study, we aimed to determine whether optimal follow-up care was provided, defined as proportion of individuals with appropriate kidney disease laboratory testing, medication prescriptions and physician visits. METHODS: We linked screening data from participants to provincial administrative data sets to evaluate whether frequencies of laboratory testing, prescriptions of disease-modifying medications, and primary care and nephrology visits differed in the 18 months before and after screening. We also conducted a propensity score matching analysis to compare outcomes between screened and unscreened adults. RESULTS: Of 1353 adults who received the screening intervention and who had complete administrative data available, 44% were at risk of kidney failure at screening. Among these individuals, frequencies of comprehensive laboratory testing (estimated glomerular filtration rate and urine albumin to creatinine ratio) improved by 17.0% (95% confidence interval [CI] 11.5 to 22.5), anti-hyperglycemic medications improved by 4.4% (95% CI 1.0 to 7.8), and nephrology visits for participants meeting referral criteria improved by 5.9% (95% CI 3.4 to 8.5). We observed significant improvements in laboratory testing, antihyperglycemic medications and nephrology visits in the screened group compared with the 1:1 matched comparison group. INTERPRETATION: Point-of-care screening programs in rural and remote Indigenous communities are adaptable methods for increasing awareness, monitoring risk and treating chronic diseases. Interventions such as the development of a national screening program could improve chronic disease care in high-risk populations. |
| Databáze: | OpenAIRE |
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