A new model improving access to tertiary chronic kidney disease care in the Western Cape - Cape York Kidney Care

Monday, May 24, 2021

A new model being implemented by the Torres and Cape Hospital and Health Service is helping to improve access to tertiary level kidney services for remote Indigenous communities of the Western Cape in Far North Queensland.

Chronic disease, including chronic kidney disease (CKD), is a major health burden for Aboriginal and Torres Strait Islander people, with many experiencing difficulties attending specialist clinics because of travel required for in-person appointments, transportation, or cultural and community expectations.

The Cape York Kidney Care (CYKC) model commenced in mid-2019 with recurrent funding facilitated by Advancing Kidney Care 2026. The model includes the use of face-to-face clinical services on county, telehealth, a multidisciplinary approach with tertiary centres, and the delivery of kidney care to all the people of the Western Cape who are known to have CKD. The service uses a rural generalist with advanced skills and a dedicated renal nurse practitioner.

Kidney Care team in the community

“The ability to go to each community, walk around and be visible, helps to engage with community members and ensure good attendance at our clinics. Sometimes too good, but we always manage!” Dr Leanne Brown, CKD Nurse Practitioner said. “We have achieved promising improvements in increased understanding and awareness of kidney disease, as well as reduced protein loss in urine, improved blood pressure and improved diabetes control.”

Dr Brown said benefits also expanded into different areas of health such as “increased immunisations, cancer screening, smoking cessation, reduced medications discrepancies, and sharing of knowledge with local Primary Health Care Centres.”

In the first 12 months of CYKC, 201 additional patients received specialist care, 171 of whom identified as Aboriginal or Torres Strait Islander. There have been $195,233 cost savings in the patient travel subsidy scheme (PTSS), which previously would have been spent on patients accessing specialist services in Cairns, and an increase in advance care planning which has helped prevent individuals being flown urgently to Cairns for treatment they did not wish for.

The CYKC program is being well received by patients too, with one quoted as saying: “I am so happy with the results and blood pressure improvement.” “[the] CYKC team explain everything [about my care], very happy” and: “[the] CYKC team ask me and include me [in my decisions about my care].”

Leanne Brown in Kowanyama

Frank Grainer, Assistant Director of Nursing, Clinical Coordination TCHHS, noted that rural and remote services needed to be innovative about how they delivered specialist care. “Ensuring all clinicians, whether they be general practitioners, nurse practitioners, allied health, or Aboriginal and Torres Strait Islander practitioners, working to their full scope and capability, allows the delivery of speciality services such as specialist kidney care,” he said.

“Maximising limited resources and ensuring an enhanced clinical capability of our rural and remote staff whilst improving access to culturally appropriate care closer to home leads to better outcomes, both physiological and psychosocial.”

So, what’s next? TCHHS is applying this model to other specialities such as ear, nose and throat in addition to cardiology and endocrinology, supporting a wholistic approach to disease management. The CYKC model also has the potential to be implemented across the Northern Cape region and other areas of Queensland.

For further details please visit the CEQ Improvement Exchange.

Last updated: 28 May 2021