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Impact of a screen, triage and treat program for identifying chronic disease risk in Indigenous children

Authors :
Brandy Wicklow
Lorraine McLeod
Allison Dart
Caroline Chartrand
Paul Komenda
Heather Martin
Barry Lavallee
Kara L. Frejuk
Oksana Harasemiw
Michelle Di Nella
Thomas W. Ferguson
Source :
CMAJ : Canadian Medical Association Journal
Publication Year :
2021
Publisher :
CMA Impact Inc., 2021.

Abstract

Background: The First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis project was a point-of-care screening program in rural and remote First Nations communities in Manitoba that aimed to identify and treat hypertension, diabetes and chronic kidney disease. The program identified chronic disease in 20% of children screened. We aimed to characterize clinical screening practices before and after intervention in children aged 10–17 years old and compare outcomes with those who did not receive the intervention. Methods: This observational, prospective cohort study started with community engagement and followed the principles of ownership, control, access and possession (OCAP). We linked participant data to administrative data at the Manitoba Centre for Health Policy to assess rates of primary care and nephrology visits, disease-modifying medication prescriptions and laboratory testing (i.e., glycosylated hemoglobin [HbA1c], estimated glomerural filtration rate [eGFR] and urine albumin- or protein-to-creatinine ratio). We analyzed the differences in proportions in the 18 months before and after the intervention. We also conducted a 1:2 propensity score matching analysis to compare outcomes of children who were screened with those who were not. Results: We included 324 of 353 children from the screening program (43.8% male; median age 12.3 yr) in this study. After the intervention, laboratory testing increased by 5.8% (95% confidence interval [CI] 1.1% to 10.1%) for HbA1c, by 9.9% (95% CI 4.2% to 15.5%) for eGFR and by 6.2% (95% CI 2.3% to 10.0%) for the urine albumin- or protein-to-creatinine ratio. We observed significant improvements in laboratory testing in screened patients in the group who were part of the program, compared with matched controls. Interpretation: Chronic disease surveillance and care increased significantly in children after the implementation of a point-of-care screening program in rural and remote First Nation communities. Interventions such as active surveillance programs have the potential to improve the chronic disease care being provided to First Nations children.

Details

ISSN :
14882329 and 08203946
Volume :
193
Database :
OpenAIRE
Journal :
Canadian Medical Association Journal
Accession number :
edsair.doi.dedup.....21610c3c9c352b64103354614741976b
Full Text :
https://doi.org/10.1503/cmaj.210507