Assessment 3 : Discussion paper on a contemporary issue

Assessment 3 : Discussion paper on a contemporary issue

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Assessment 3: Discussion paper on a contemporary issue

Assessment Type: Discussion Paper- Essay

Weighting:(40%)

Word count:2000 words

Unit Learning Outcomes:1,2

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Due Date: Week 12: 8am Friday 20th October 2023Word count: 2,000 wordsFormatting: As per ECU SNM assignment presentation guideSubmission : OnlineInstructionsChronic kidney disease (CKD) is an increasing global public health threat (Bello et al., 2017).Australia is not immune to the problem. The prevalence of CKD among Australian adultsaged 25 increased from an estimated 1 million to 1.5 million between 1999 and 2012(Australian Institute of Health and Welfare, 2018). It is predicted in meeting the healthneeds of people with CKD expenditure on the delivery of healthcare services will continue toincrease (Tucker, Kingsley, Morton, Scanlan, & Dalbo, 2014).

1. Describe Australias challenges and achievements in meeting the health needs of individualswith CKD ( Approx. word count 1000).

2. Compare and contrast how high income countries such as Australia manage CKD comparedwith low-income countries (Approx. word count 700).

Introduction- (Approx. 150 words)

Conclusion (Approx.150 words)

You will need to explore the literature, however where possible a focus on the current literature isrequired. Minimum of 10 primary research articles should support your argument.

ReferencesAustralian Institute of Health and Welfare. (2023). Chronic kidney disease : Australian factshttps://www.aihw.gov.au/reports/chronic-kidney-disease/chronic-kidney-disease/contents/aboutLinks to an external site.Bello, A. K., Levin, N. W., Tonelli, M., Okpechi, I. G., Feehally, J., Harris, D., . . . Johnson, D. W. (2017).Assessment of global kidney health care status. JAMA, 317(18), 1864-1881 doi:1810.1001/jama.2017.4046.

https://pubmed.ncbi.nlm.nih.gov/28430830/Links to an external site.Tucker, P. S., Kingsley, M. I., Morton, R. H., Scanlan, A. T., & Dalbo, V. J. (2014). The increasingfinancial impact of chronic kidney disease in Australia. International Journal of Nephrology,Article ID 120537 http://dx.doi.org/120510.121155/122014/120537.

https://pubmed.ncbi.nlm.nih.gov/24800075/Links to an external site.

Discussion paper on a contemporary issue

Student one

SID00000

School of Nursing and Midwifery, Edith Cowan University NUR 6119 Nursing Management of Chronic Health Condition

Dr. Ulrich Steinwandel

21/10/2022

2192 words

Introduction

Chronic kidney disease (CKD) is one of the major public health diseases in the world.

Globally, 13.4% of patients are suffering from end-stage kidney disease (ESKD). It is a

progressive and irreversible disease with a higher cardiovascular risk. Therefore, it directly

affects the global burden of morbidity and mortality (Ammirati, 2020). The global rise in CKD is often due to an increase in the prevalence of diabetes mellitus, hypertension, obesity, and aging. However, some regions still have other causes including infections and environmental toxins (Lv& Zhang, 2019). CKD impacts about one in ten Australians every year, and 110 people out of every million, initiate therapy for renal failure (Muscat et al., 2021). Hence, it is an important topic to concern. This essay will discuss the challenges, and achievements and contrast CKD management in Australia with other countries.

Challengers

Between 1999 and 2012, the prevalence of moderate and severe CKD nearly doubled in Australia. The reason behind this was increasing the older population and improving the survival rate due to receiving renal replacement therapy (RRT). Furthermore, it lost about 49,300 years of healthy life for Australians in 2018 (Australian Institute of Health and Welfare [AIHW], 2022). Thus, it impacts the workforce and productivity of the country. The growing number of cases leads to an increase in the demand for RRT, particularly with the dialysis centers, infrastructure, health funds, and maintenance.

In Australia, a significant amount of culturally and linguistically diverse groups are living in rural and remote locations. Poor socioeconomic conditions in rural areas lead to many disadvantages, including lower household income, less education, and less access to primary

health care and specialist services. As a result, people may not be able to get referred to a nephrologist promptly, which can lead to an increased need to relocate for treatment, and an inability to retrieve treatment. Considering the Aboriginal and Torres Strait Islander adults in remote areas, 39% have a heavier burden with CKD. In 201213, the prevalence of CKD was 6.6 times higher among them than in non-indigenous Australians. Moreover, their hospitalization rates were 10 times greater than non-native citizens. Hence, it is a significant health problem for native people in remote areas (Nagel et al., 2020).

In the northern territory of Australia, the majority of native people with ESRD who are on dialysis must travel several hundred kilometers from their remote residential communities to access centrally-based assisted hemodialysis, which requires at least three times per week. Furthermore, they have to devote their time away from home for surgical procedures, and training for home-based dialysis, and require excessive leaves to attend treatment procedures. As a result, they often face financial burdens, and this is exacerbated by transportation and accommodation expenditures. Moreover, long travel times increase the risk of mortality,

decrease the quality of life, and reduce the uptake of RRT (Scholes-Robertson et al., 2022).

People who have CKD are often associated with physical inability and loss of cognitive capabilities, role in the family, and workplace. Patients in rural areas experience stress, depression, and anxiety as a result of grief because of the loss of their family members, friends, relationships, independence, careers, and financial insecurity. A study revealed that the main

reason for missing treatment attendance was social isolation and intense solitude during HDtreatment (Nagel et al., 2020). Therefore, more implication is required to combat psychological issues.

Australian native people require holistic health care with appropriate medical, social, and

cultural needs along with native health workers in both rural and urban settings. Thus, providing

optimal treatment can be challenging (Hughes et al., 2019). Although multidisciplinary team (MDT) assistance is essential to address the numerous aspects of the condition, it is a challenging task for a large country such as Australia to provide health professionals in every part of the country. Furthermore, building infrastructures and providing advanced medical facilities with professional staff in a wide range of areas require higher capital and a difficult task. Australia has a major challenge in equally distributing health care through a vast geographical area (Damasiewicz & Polkinghorne, 2020). Additionally, indigenous people with CKD often experience with lack of health literacy. It is a crucial factor for the self-management of CKD.

This is one of the barriers to access to health care and decision-making on health care (Muscat et al., 2021).

Achievements

In 2020, 27700 kidney failure patients received RRT. Among them, 47% had undergone kidney transplants and 53% received dialysis (AIHW, 2020). Dialysis facilities, infrastructure, and specialist services in Australia gradually expanded over the past decades. For instance, in

1980 there were 4 dialysis centers in Queensland. This was expanded to 12 in 1997 and in 2016 number rose to 30 units (Yaxley & Meagher, 2022). Moreover, dialysis was refused in the 1980s for diabetic patients over the age of 60 due to poor prognosis, technological limitations, and demand. Owing to the new technology, these facilities are widely open for most patients and increase life expectancy. The Australian government has implemented numerous strategies to improve the health system from time to time. Escalating home dialysis services, public and

private partnerships, and twilight dialysis shifts are a few of them (Damasiewicz & Polkinghorne, 2020).

During the past years, the number of renal nurses and other health professionals has increased in Australia. Currently, there is a 1:31:4 nurse-to-patient ratio in dialysis centers (Damasiewicz & Polkinghorne, 2020). In 2000, there were 23 nephrology trainees in Australia. This number increased to 106 in 2014. It is a challenge to recruit and train skillful staff commensurately with growing the demand for healthcare facilities. However, many workforce strategies were introduced by the government from time to time. Recruiting Aboriginal staff, national and international recruitment of dialysis nurses and nephrologists, dialysis nurse exchange programs, knowledge exchange, and skill development programs are a few successful programs (Gorham et al., 2018).

Australia has established many policies to improve renal medicine and services, especially for disadvantaged groups. For instance, in 2018 the government introduced a Medicare Benefits Scheme to provide funding for care CKD patients in primary care centers in remote areas. Rural Health Outreach Fund, Medical Outreach - Indigenous Chronic Disease Program, and Stronger Rural Health Strategy have contributed to increasing access to health professionals in regional locations. Furthermore, Medicare health assessment has widely expanded for indigenous people to obtain health checks freely or with a minimum claim (Dominello et al., 2021).

Telenephrology has merged rural CKD people into health care through web-based platforms and applications, and video conferences. Telemedicine has been exhibited to be a successful way of transfer of health records electronically and connecting MDT with regional CKD patients (Venuthurupalli et al., 2018b).

Government services and community-led services have acted on the needs of CKD patients. These programs include relocatable self-care facilities, the mobile dialysis bus, and training of Aboriginal health workers. Although mobile dialysis services are expensive, mobile dialysis buses have been introduced in 2010 for remote communities. These facilities provide on- site dialysis with 8 patients. Furthermore, programs such as Purple House provide substantial support for patients and families including social support, and accommodation needs for local patients (Gorham et al., 2018). Kidney Kids program assists children with CKD by providing airfare and accommodation facilities. Kidney Kids camp, Western Australias annual adult holiday camp provides holiday services for rural families. FAITH housing program assists patients with accommodations in Western Australia. Kidney health information service support and provide information for CKD patients. Kidney Community posts a monthly newsletter for rural houses, that cannot access the internet (Kidney Health, 2020).

In 1980, 40 kidney transplants were done annually in Australia. Currently, this number has been escalating by about 175 per year. In 1988,1000 KT was celebrated and 5000 was celebrated in 2021. Moreover, the post-transplant mortality rate has dropped from 15% to 5%. During the past decade, new technologies, devices for hemodialysis (HD), transplant procedures, the research sector, medication such as antimicrobial prophylaxis, and diagnosis methods, were greatly improved in Australia (Yaxley & Meagher, 2022).

Comparing CKD management with other countries

Comparing the prevalence of RRT, in many low-income countries incidence rate is increasing. Whereas RRT prevalence is stable or even decreasing in many high-income

countries. The number of RRT patients who receive dialysis treatment is primarily determined by economic strength. Many low- and middle-income countries have impediments to affording

consumables that require RRT as they need foreign currency to import or transport them. Considering the percentage of reimbursement expended on HD and peritoneal dialysis (PD), high-income countries, middle-income countries, and low-income countries represented 80%,

17%, and 3% respectively (van der Tol et al., 2019). Complete government funding for RRT is a challenging task for many countries. A survey conducted among 118 countries reported, only42% of countries provided hemodialysis and 51% with long-term PD, and 49% provided kidney transplantation freely for the public. Among these rates, most high-income countries offered complete public funding for RRT (Bello et al., 2017).

There is a significant variation in the availability and accessibility of health care and technologies among the nations. Considering the facilities for RRT, 95% of countries have resources for HD, 76% for long-term PD, and 75% for kidney transplantation (KT). Developed nations have these facilities 100% (Bello et al., 2017). Australia consists of health facilities for various types of dialysis methods in different settings such as home hemodialysis, inpatient hemodialysis, satellite hemodialysis, PD, and continuous ambulatory peritoneal dialysis (Victorian Public Hospitals and Health Services, 2015).

In terms of health service delivery, 38% of countries have good infrastructure for CKD care, and 7% have excellent facilities. Africa, South Asia, and North America reported low infrastructure facilities for AKI and CKD. Renal biopsy and other pathological services in secondary care settings are available in only 27 countries. In contrast, these facilities are not available in 14% of countries (Bello et al., 2017). Moreover, several Asian countries, Africa, and Latin America indicated a low nephrology workforce with 10 per 1 million population density. Japan, Taiwan, and Lithuania reported a higher number of nephrologists. Due to globalization, many health professionals tend to migrate to developed countries including nephrologists.

Surveillance and monitoring system is efficient for managing renal health. Most developed countries maintain dialysis and KT registries properly, while Africa, South Asia, and Middle East countries maintain RRT registries insufficiently (Bello et al., 2017). Australia and New Zealand Dialysis and Transplant Registry is the leading advanced surveillance system in Australia (Venuthurupalli et al., 2018a).

There are various national strategies among the nations for caring for CKD patients. Only

17% of countries have a specific framework for CKD management. In contrast, 51% of countries have no specific approach (Bello et al., 2017). Australia has a National Strategic Action Plan to address kidney diseases. This mainly focuses on detecting, preventing, and educating the

citizens, providing the best care for the patients, and improving the research facilities (Kidney health, 2020).

Advocacy groups for CKD are inadequate in many countries (Bello et al., 2017).

Australia consists of many advocacy groups for advocates vulnerable groups such as native CKD patients in rural areas. The primary education advisory committee of kidney health Australia, the Hunter and northern kidney association, and the Aboriginal dialysis support group, are a few support groups for Australian citizens (Kidney Health, 2020).

Research and development are efficient components for a country to manage CKD. Availability of infrastructure, skilled workforce, and ethical frameworks are important components of it. Many developing nations show a lack of ability to perform clinical trials. Whereas most developed nations can conduct all phases of clinical trials. Most Middle East countries and African countries represent a lack of capacity to take part in cohort studies in transplantation (Bello et al., 2017). National Health and Medical Research Centre was established in 2015 to improve the research sector of Australia (Venuthurupalli et al., 2018a).

Moreover, a study illustrates early diagnosis and referral to a nephrologist impact to reduce 44% of 5 years of mortality and shortens the hospitalization period by 9 days. This means that awareness of CKD and screening are efficient factors for managing CKD. Low-income and middle-income countries indicate a lack of awareness due to limited access to healthcare (Ng & Li, 2018). Red Socks Walk was conducted in several states of Australia to increase awareness and collect funding for combating kidney diseases (Kidney Health, 2020). Australia has conducted many screening programs such as AusDiab study, and Kidney Evaluation you to prevent CKD (Venuthurupalli et al., 2018a).

Conclusion

CKD is one of the leading public health problems in the world. The global burden of the condition is markedly increasing throughout the world. Over the past decades, the prevalence of CKD has increased in Australia due to the growth in the older population. As a result, the requirements for RRT also increased with the incidence rate which is a challenge for the country. Australia has major disparities in the distribution of health for CKD patients with regional indigenous populations. However, healthcare facilities and life expectancy have broadly developed throughout the past eras. The government has implemented many strategies toimprove renal health services including funding, changing policies, and recruiting health staff. Early detection and screening are important for the management of CKD, especially in high-risk groups.

References

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Damasiewicz, M. J., & Polkinghorne, K. R. (2020). Global dialysis perspective: Australia. Kidney360, 1(1), 48.

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https://kidney.org.au/get-involved/advocacy/national-strategic-action-plan-for-kidney-

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van der Tol, A., Lameire, N., Morton, R. L., Biesen, W.V., & Vanholder, R. (2019). An international analysis of dialysis services reimbursement. Clinical Journal of the American Society of Nephrology, 14(1), 84-93.

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