Cape York Kidney Care (CYKC) is a unique model of care established in 2019 for the Western Cape area of the Torres and Cape Hospital and Health Service in Queensland. The CYKC service looks after more than 500 people with chronic kidney disease (CKD) in six remote communities. The Western Cape First Nations communities have a very strong connection to land and community, where local language is used and cultural protocols and land management practiced. However, due to many factors, these communities are some of the most disadvantaged in Australia.
The health disparity in these communities is high, with a gap in life expectancy of more than 20 years compared to the overall life expectancy of First Nations people in Australia. Healthcare models where care is delivered in the communities by a multidisciplinary team have been shown to have greater acceptance by patients and represent savings in travel costs and travel time. Research has also shown that multidisciplinary care in addition to specialist input reduces the risk of progression of CKD and cardiovascular complications.
The CYKC model consists of a general practitioner (GP) with internal medicine training, nephrology nurse practitioner (NP), dietitian, Aboriginal or Torre Strait Islander health practitioner and pharmacist.
The NP works in synergy with the GP, with each health professional able to fulfill the other’s role. This ensures the sustainability of the program, as well as consistent support and management strategies. The mission statement of the CYKC model is:
The CYKC team is committed to improving people’s heart and kidney health. We do this by yarning and learning about what is important to you and your family. Together we can empower you to be healthy and live a long life, help to stop the need for dialysis, keeping you connected and communities strong.
The CYKC team ensures specialist care is provided within the primary care clinics and provides a holistic care approach with case management and intensive follow-up. During clinical consultations, the team also gains an understanding of social barriers to adherence, improves client understanding of their health, and helps to support self-management and shared decision-making in a culturally appropriate manner. Often the NP or GP will address issues unrelated to kidney disease such as respiratory conditions, skin complaints, fractures, wound infections and, sometimes, acute presentations requiring evacuation out.
Importantly, CYKC have significantly improved access to specialist services in the communities, with more than 300 people who did not previously access care now receiving specialist services. This has been undertaken on a small budget (less than $1 million per year) and we believe there have been significant cost savings generated by delayed dialysis, reduced CVD risk and undertaking planned-start dialysis (home-based therapies as treatment of choice for some). Furthermore, access has been improved for those in remote communities to receive a kidney transplant (three transplants in two years compared to none in the two years prior to the program), with wait times from commencement of dialysis to receipt of kidney transplant greatly reduced. The NP has played a key role in the improvement of dialysis preparation and transplant workup.
Preliminary analysis of health outcomes has shown that there has been a significant reduction in hypertension and a reduction in proteinuria. In addition, many of the clients are now receiving evidence-based care in relation to reducing cardiovascular events and slowing CKD progression. The CYKC has received grant funding from the Tropical Australian Academic Health Centre to evaluate the health outcomes and economics of this program. We expect to report on this next year.
The limitation of the model is sustainability of the workforce due to the heavy demands that outreach services place on staff members, as well as the requirement for speciality knowledge that both the NP and GP provide. The Australian Government has recently recognised the need for health services to build a proficient and resilient NP workforce. However, this has yet to translate into support for development of NP roles or funding for NP candidate positions. Unfortunately, this is a risk for the CYKC model due to the heavy dependence on the NP role and lack of health service support for NP candidates to work alongside the NP, which would facilitate mentoring and succession planning.
The NP role within CYKC, and in rural and remote areas, is essential to address primary healthcare needs for First Nations communities.