NorWest Mobile Diabetes and Kidney Screening and Intervention Project. Cindy Peters Primary Care Nurse

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Randolph Norman
5 years ago
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1 NorWest Mobile Diabetes and Kidney Screening and Intervention Project Cindy Peters Primary Care Nurse

2 Interprofessional and Intersectoral partnerships

3 Aims of FINISHED (First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis) Partnership between the Diabetes Integration Project and Manitoba Renal Program Goal: To improve the health of First Nations communities though screening and treatment of kidney disease to prevent kidney failure requiring dialysis. 1. Screen for kidney disease in high risk, underserviced communities Instant, direct feedback to clients on level of risk 2. Refer clients at risk to appropriate treatments 3. Enter risk scores and information into the electronic Kidney Health record. 4. Use project results to convince MB Health and Health Canada that screening should be permanently funded

4 Aims of NorWest Project Through screen/triage/treat clinics identify: Individuals at risk for developing diabetes, hypertension or kidney disease Individuals with diabetes who may not have been screened for complications 5 year kidney failure risk prediction To provide follow up to those with risk factors (connect to primary care/chronic disease team, primary care provider, specialty care, other supports)

5 Key Partners

6 Rapid testing = 6-12 min Point of Care Testing & Instant Risk Prediction Finger prick for blood and small urine sample egfr, Ca, PO4, T-CO2, Albumin, Urine ACR, HgbA1C Real time tablet-based data entry custom app for this project Equipment undergoes quality assurance process each day to ensure precision and accuracy Mobile Chemistry Analyzer A1C/ACR Analyzer

7 Rationale MB has among the highest rate of kidney failure in all of Canada Screening general population is not recommended Focus on hard to reach high risk population groups (targeted screening) Prevent dialysis (determine 5 year risk prediction) Increase access to supports (primary health care)

8 At the screen/triage/treat clinics we will Obtain informed consent, complete health questionnaire Measure blood pressure (6 readings) Finger prick blood sample Urine sample Results are available within about 15 minutes (usually will spend about minutes to complete entire process) Education provided based on results Classified according to kidney disease risk level (4 categories of risk) Letters sent to primary care provider if applicable (if blood sugar or blood pressure elevated or kidney risk score indicates requires follow up Referral made to nephrology(kidney specialist)depending on risk level

Screening Blood Pressure egfr, Ca, PO4, HCO3, albumin Urine ACR HbA1c Risk Prediction No Current

0 HgA1c <7% and No known DM Low Risk egfr <60 and 1-3% risk of kidney failure over 5 yr OR

0 > ACR > 100 Intermediate Risk 3-10%risk of kidney failure over 5 yr OR 100 < ACR < 200 High

Exercise Treatment Lifestyle counseling Diet and exercise Letter to primary care practitioner

9 Screening Blood Pressure egfr, Ca, PO4, HCO3, albumin Urine ACR HbA1c Risk Prediction No Current Risk BP <160/90 egfr > 60 ACR = < 3.0 HgA1c <7% and No known DM Low Risk egfr <60 and 1-3% risk of kidney failure over 5 yr OR BP>160/90 OR HgA1c>7% OR 3.0 > ACR > 100 Intermediate Risk 3-10%risk of kidney failure over 5 yr OR 100 < ACR < 200 High Risk >10%/ 5 yr risk of kidney failure OR ACR > 200 Treatment Lifestyle counseling Diet and Exercise Treatment Lifestyle counseling Diet and exercise Letter to primary care practitioner Flag for yearly rescreening Treatment Lifestyle counseling Diet and exercise Arrange referral to MRP for evaluation by a nephrologist Treatment Lifestyle counseling Arrange urgent referral to the MRP for detailed evaluation by a nephrologist & team

10 Consent

11 Consent

12 Consent

13 Point of Care Testing blood pressure

14 Point of Care Testing blood and urine

15 Point of Care Testing

16 Education

17 Findings May 2015 July 2016 (total of 103 screening days) 430 community members screened: 219 First Nations, Inuit or Metis 65 Filipino 44 South Asian 102 Other ethnicities No risk 284 Low risk 137 Intermediate risk 5 High risk 3 81 referrals to attach to primary care provider 74 referrals to diabetes education 108 referrals to registered dietitian (194 for group education) 34 referrals for smoking cessation 67 referrals to foot care education 14 referrals to counseling supports

18 Demographic Characteristics of Screening Cohort Findings First Nations South Asian (n = 219) (n = 44) Filipino (n = 65) Other (n = 102) Age (years) 41 (13.6) 43.2 (15.6) 54.1 (13.8) 55.5 (15.9) Sex (% female) 64.8% 65.9% 53.9% 72.6% HgbA1C (% 6.5%) 14.2% 4.7% 24.6% 22.8% egfr (ml/min per 1.73 m 2 ) (42.6) (60.7) 98.3 (40.9) (37.2) egfr (ml/min per 1.73 m 2 ) (% < 60) Urine ACR (mg/mmol) 3.2% 2.3% 12.3% 6.9% 1.8 ( ) 1.9 ( ) 1.9 ( ) 1.9 ( ) Albuminuria (% 3 mg/mmol) 14.2% 4.7% 20.0% 18.6% Chronic Kidney Disease (egfr < 60 or Urine ACR > 16.0% 6.8% 24.6% 21.6% 3 mg/mmol) Elevated Blood Pressure ( 140 mmhg SBP or 90 mmhg DBP) Systolic BP (mmhg) 17.4% (14.2) 13.6% (16.8) 23.1% (19.1) 25.5% (21.6) Diastolic BP (mmhg) 78.4 (10) 75 (8.4) 77.5 (10.8) 76.9 (13.4) Kidney Failure Risk (Item S1) No Risk 67.0% 86.1% 55.0% 64.3% Low Risk 31.7% 14.0% 38.3% 33.7% Int. Risk 0.9% 0.0% 1.7% 2.0% High Risk 0.5% 0.0% 5.0% 0.0% Summary statistics given as mean ± SD for normally distributed variables, median (interquartile range) for non-normally distributed variables, and percentages (N) for categorical variables. Some categories may not sum to 100% due to rounding. HgbA1C: Glycated Hemoglobin, SBP: Systolic Blood Pressure, DBP: Diastolic Blood Pressure. The criteria for determination of kidney failure risk are presented in Item S1.

19 Findings Further extrapolation of data from Manitoba Centre for Health Policy (MCHP) is underway Data analysis will be collated from a variety of databases including income, education, billing data, laboratory data as well as other social complexity measures Phase 2 focus on children, youth and families with risk factors

20 Training and Capacity Building 2 Project Leads 8 staff trained on operating procedures to run clinics Capacity Development Week provided by partners Collaboration of DIP and MRP training on use of POC equipment, operating procedures and community outreach Shadowing screening clinics in Rolling River First Nation, MB

22 Promotional pamphlets Community Engagement Strategy and Outreach Involvement of Community Development team, Indigenous outreach worker, Immigrant Settlement Program Presented at networks and advisories Community leaders Food Banks / Resource Centres Leaflets to MB housing residences Promoting to those working in community (EIA) WRHA Diabetes Network partners

24 Thank you to our Partners!

25 Thank you! Join Us

Key Elements in Managing Diabetes

Key Elements in Managing Diabetes Presentor Disclosure No conflicts of interest to disclose Presented by Susan Cotey, RN, CDE Lennon Diabetes Center Stephanie Tubbs Jones Health Center Cleveland Clinic