DEVELOPING GUIDELINES TO ADDRESS HEALTH EQUITY IN CHRONIC KIDNEY AMONG FIRST NATIONS PEOPLES IN AUSTRALIA AND AOTEAROA NEW ZEALAND

 

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https://storage.unitedwebnetwork.com/files/1099/4d6457beef3dfefa7eafb4273c5ed980.pdf
DEVELOPING GUIDELINES TO ADDRESS HEALTH EQUITY IN CHRONIC KIDNEY AMONG FIRST NATIONS PEOPLES IN AUSTRALIA AND AOTEAROA NEW ZEALAND

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David
Tunnicliffe
David Tunnicliffe david.tunnicliffe@sydney.edu.au The University of Sydney Centre for Kidney Research Sydney Australia *
Suetonia Green suetonia.green@otago.ac.nz The University of Otago Faculty of Medicine Christchurch New Zealand -
Richard Phoon richard.phoon@sydney.edu.au The University of Sydney Westmead Hospital Sydney Australia -
Brydee Cashmore brydee.cashmore@sydney.edu.au The University of Sydney Centre for Kidney Research Sydney Australia -
Ieyesha Roberts ieyesha.roberts@sydney.edu.au The University of Sydney Centre for Kidney Resaerch Kempsey Australia -
Vincent Lee vincent.lee@sydney.edu.au The University of Sydney Centre for Kidney Research Sydney Australia -
Rathika Krishnasamy rathika.krishnasamy@health.qld.gov.au Sunshine Coast University Hospital Bira Birtinya Australia -
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The ongoing colonisation of Australia and New Zealand have resulted in First Nations Peoples experiencing substantial marginalisation, resulting in an excess burden of chronic kidney disease (CKD) among Aboriginal and Torres Strait Islander Peoples, and Māori. Clinical practice guidelines have traditionally been developed with a Western biomedical view and have not incorporated the Indigenous holistic view of health. To describe the development of guidelines on managing CKD among Aboriginal and Torres Strait Islander Peoples and guidelines on the management of CKD for Māori in Aotearoa New Zealand.

We undertook targeted community consultation to ensure the priorities of the First Nations communities were identified and incorporated into the guidelines scope. We searched literature databases in May 2022 and summarised findings using narrative synthesis. The studies were appraised using appropriate study design tools, and as the involvement of First Nations Peoples. A multidisciplinary expert Working Group interpreted the findings and drafted recommendations that received feedback from community reference groups and leading Indigenous health organisations and experts.  

The development of these guidelines involved 16 community consultations. The inclusion of First Nations Peoples in the 422 included studies were poorly reported and undertaken in most studies. The knowledge gained from the community consultations was incorporated into the Australian guidelines through the Four C’s (community voice, clinical evidence, cost, equity and resources, cultural safety considerations) to support guideline recommendations. In the Māori guidelines, an evidence alignment scheme was developed that considered of the reporting of First Nations Peoples involvement in included studies, the involvement of Māori stakeholders, and the consistency of findings across studies using unique Māori language and knowledge. The guidelines have uniquely developed 36 recommendations focused on institutional racism, earlier diagnosis and referral to kidney health services, and increased rural and remote dialysis.  

These are the first guidelines to address chronic kidney disease management among First Nations Peoples. The guidelines have led to $73.4 million in funding for community-controlled dialysis centres across Australia, and the establishment of the Indigenous Health Advancement working group of national society of Nephrology to address institutional racism and improve service delivery. 

Kewords