Study | Objective | Study design | Setting | Intervention and comparator | Comparator | Participants | Outcomes measured |
---|---|---|---|---|---|---|---|
Tan et al. (2014) [23] | To determine the effectiveness of a PHC-based, nurse-led CKD program with Tongan staff can improve medication adherence and clinical outcomes | 2-year prospective uncontrolled cohort study, conducted 2011 – 2013 | NZ urban area, PHC service in Auckland with Tongan-speaking staff | Nurse-led with input from GP and diabetologist when necessary. Focus on prescribing antihypertensives and improving adherence. BP measured 2–6 weekly. Some outreach and lifestyle, dietary and self-care education. | No comparator. | 43 Pasifika patients with type 2 diabetes, CKD (mostly stages 2 and 3) and hypertension. Mean age 53 years, 77 % male. 39 available for follow-up at ≥17 mths. | BP, no. antihypertensives, eGFR, ACR, HbA1c |
To test feasibility and effectiveness of a specialist renal nurse-led self-management intervention to slow progression of CKD. | 1 year prospective uncontrolled cohort study, conducted 2011–2012. | NZ, rural area; two PHC practices in Hawke’s Bay. | Specialist nurse-led partnership with primary care clinicians. Focus on coaching to improve self-management. Individual educational and clinical care plans developed followed by 12 weeks of fortnightly self-management sessions, with monitoring to 12 months. Some outreach and free care, medications and transport. | No comparator. | 52 patients (37 NZ Māori, 10 Cook Island Māori/Samoan and 5 NZ European) with type 2 diabetes, CKD | BP, no. antihypertensives, eGFR, ACR, HbA1c, self-management. | |
Hotu et al. (2010) [22] | To determine whether a nurse-led community-based CKD program involving a Māori or Pasifika health care assistant (HCA) (‘community care’; CC) is more clinically effective than ‘usual care’ (UC). | 1 year RCT, conducted 2004–2006. | NZ, urban area; hospital clinics and PHC services in Auckland. | Nurse-led with focus on prescribing antihypertensives and improving adherence. Monthly outreach by HCA to monitor BP, promote adherence and provide free transport. Lifestyle, dietary and self-care education. Received routine care as necessary. | Lifestyle, dietary and self-care education. Usual care by GP and renal clinic. | 65 Māori and Pasifika patients with type 2 diabetes, CKD (mostly stage 3) and hypertension (CC: n = 33; UC: n = 32). Mean age: CC: 63; UC: 60 years; % male: CC: 55 %; UC: 53 %. 58 available for follow-up at 12 months (CC: n = 30; UC: n = 28). | BP, no. antihypertensives, adherence, eGFR, ACR, HbA1c. |
Shephard et al. (2006) [27] | To determine the clinical effectiveness (and acceptability- see below) of the Umoona Kidney Project, a PHC-based partnership between the local Aboriginal community controlled health service (ACCHS) and visiting specialists from Adelaide. | 2 year prospective uncontrolled cohort study, conducted 1998–2000. | Australia, remote area; ACCHS in Coober Pedy. | Specialist-run with focus on prescribing antihypertensives, delivering ACR point of care tests (POCT) and ascertaining acceptability of project. Regular visits by nephrologists and 6-monthly monitoring of clinical parameters. Lifestyle and dietary education provided. Some outreach. | No comparator. | 35 Aboriginal patients with hypertension and with or at risk of CKD (20 had albuminuria). Mean age 49 years, 54 % male. Patients followed for a mean of 15 months with none lost to follow-up. | BP, no. antihypertensives, adherence, eGFR, ACR, program acceptability. |
Kondalsamy-Chennakesavan (2003) [26] | 1) To determine whether improvements in BP and metabolic control were sustained following the handover of the visiting specialist-run MRTP to the local THB. 2) To compare the effectiveness of the pre-handover MRTP to the concurrently run THB-managed CCT. | 2.5 and 5.5 year retrospective uncontrolled cohort study, comparing cohorts: 1) 66 month MRTP cohort (n = 101) comparing pre-handover (1995–1999) and post-handover (2000–2001). 2) 30 month MRTP (n = 149) and CCT (n = 89) cohorts comparing pre-handover MRTP to CCT (1997–2000). | Australia, remote area; ACCHS on the Tiwi Islands, 80 km north of Darwin. | The MRTP was a specialist-run project that ran alongside the local health care facilities. The focus was prescribing antihypertensives. Lifestyle and dietary education delivered and individual treatment plans developed. Systematic recalls and active follow-up to monitor BP. | CCT patients assigned a chronic disease care plan and were managed in routine PHC setting. No specific resources for renal patients, opportunistic follow-up, less systematic medical oversight. | 238 Aboriginal patients with hypertension and/or CKD (mostly stages 1 and 2). Mean age: MRTP: 44; CCT: 42 years; % male: MRTP: 45 %; CCT: 44 %. | BP, HbA1c. |