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Impact of a screen, triage and treat program for identifying chronic disease risk in Indigenous children
Kara L Frejuk1, Oksana Harasemiw1, Paul Komenda1
1Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man.
Insights
A community screening program in First Nations communities improved chronic disease care for children. This initiative enhanced surveillance and treatment for conditions like hypertension and diabetes, leading to better health outcomes.
Area of Science:
- Public Health
- Pediatric Nephrology
- Indigenous Health
Background:
- A point-of-care screening program was implemented in rural and remote First Nations communities in Manitoba to address hypertension, diabetes, and chronic kidney disease.
- The program identified chronic diseases in 20% of screened children, highlighting a significant need for intervention.
Purpose of the Study:
- To evaluate clinical screening practices in children aged 10-17 years before and after the intervention.
- To compare health outcomes of children who received the screening intervention with those who did not.
Main Methods:
- An observational, prospective cohort study adhering to OCAP principles was conducted.
- Data on primary care visits, nephrology referrals, medication prescriptions, and laboratory tests (HbA1c, eGFR, urine albumin/protein-to-creatinine ratio) were analyzed.
- Propensity score matching was used to compare screened children with a control group.
Main Results:
- Laboratory testing for HbA1c, eGFR, and urine albumin/protein-to-creatinine ratio significantly increased post-intervention.
- Improvements in laboratory testing were significantly greater in the screened group compared to matched controls.
Conclusions:
- The point-of-care screening program substantially improved chronic disease surveillance and care among First Nations children.
- Active surveillance programs hold significant potential for enhancing chronic disease management in Indigenous children.
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.
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