A nurse-managed kidney disease program in regional

and remote Australia

Kim Tracey, Tania Cossich, Paul N Bennett, Steven Wright & Cherene Ockerby
Tracey, K., Cossich, T., Bennett, P.N., Wright, S., & Ockerby, C. (2013). A nurse-managed kidney disease program in regional and
remote Australia Renal Society of Australasia Journal, 9(1), 28-34.
Submitted April 2012, Accepted November 2012

Abstract
Health services that aim to prevent and manage chronic kidney disease (CKD) in rural and remote Aboriginal communities
in Australia, including the Goldfields region of Western Australia (WA), require innovative approaches. Nursing roles can
significantly improve access to renal services in rural and remote areas as they are able to address a range of renal health
promotion and prevention activities, and provide renal clinical education and support to Aboriginal people. The Goldfields
Kidney Disease Nursing Management Program (GKDNMP), funded through the Council of Australian Governments (COAG)
National Partnership Agreements, was developed to provide a comprehensive approach to primary health care that incorporates
a range of health promotion and disease management activities. In the first year, the program increased home dialysis rates and
decreased patient travel due to expanded access to renal care within the region. Context-specific health programs generated in
response to local needs can be successful in addressing specific health care challenges in rural and remote health.

Keywords Chronic kidney disease, dialysis, renal, implementation, Indigenous, primary care, prevention, remote, nursing.

Aim that provides palliative symptom management (Davison, 2011;

Sedgewick, Noble, Ho, Kafkia & Van Waeleghem, 2010).
The aim of this paper is to report on a nurse-managed model
of care to improve renal care in rural and remote Aboriginal Factors that increase the risk of CKD can be predetermined
communities in the Goldfields region of WA. The GKDNMP such as age, family history, ethnicity and gender. Other factors
has been developed using key indicators identified by are behavioural (for example, tobacco smoking, nutrition and
COAG who funded the three-year program. The program inactivity) or may be due to underlying health conditions
aims to improve renal health services in the region through including diabetes, hypertension, cardiovascular disease,
improved access to local renal services to reduce relocation obesity and systemic diseases (Australian Institute of Health
to Perth. Program staff provide screening and early detection and Welfare, 2009; Chadban et al., 2003; White et al., 2011;
of Aboriginal people at risk of, or with, CKD and provide White, Polkinghorne, Atkins & Chadban, 2010). The five
appropriate management and comprehensive care across the major causes of CKD death include circulatory diseases,
disease continuum. The program operates in consultation with diabetes, cancer, respiratory diseases, injury and poisoning,
Aboriginal communities and uses and promotes culturally secure compounded by lifestyle and risk behaviour and limited
practices in care delivery. access to effective services (Department of Indigenous Affairs,
2008). The identification of early-stage CKD and early
Background prevention of progression is critical to ensure people receive
Major disease-specific, health-related measures in Australia vary appropriate management to delay, minimise or halt disease
between Aboriginal and non-Aboriginal people. Chronic kidney progression (Kidney Health Australia, 2012). This may include
disease (CKD) exemplifies this as Aboriginal Australians were fluid management, cessation of nephrotoxic medication and
five times more likely than non-Aboriginal people to have CKD commencement of angiotensin converting enzyme inhibitors
recorded on their death certificate between 2003 and 2007 (Sinclair & Bennett, 2011).
(Australian Institute of Health and Welfare, 2010). CKD refers to Nursing has a significant role in facilitating equity in health care
all diseases of the kidney where a person has evidence of kidney and improved access to services and health care outcomes. The
damage and/or reduced kidney function that lasts for more than broad scope of the role and its application in rural and remote
three months (Australian Institute of Health and Welfare, 2009). communities beyond the acute setting has been previously
A person with end-stage kidney disease has over 85% loss of noted and requires full use of the role of nurses (Cerasa, 2011;
kidney function and requires renal replacement therapy, such Van Camp, Huybrechts,Van Rompaey & Elseviers, 2011).
as dialysis or transplantation, to continue life for an extended While nursing roles in rural areas tend to be generalist (Francis
period of time (Kidney Health Australia, 2012). Supportive & Mills, 2011), an increased number of nurse practitioners
care without dialysis or transplantation is an alternative option (NPs) working in remote areas is required (Wakerman, Curry

Author details Kim Tracey RN, Clinical Nurse Manager, Goldfields Regional Renal Service and Nurse Practitioner Candidate,
Kalgoorlie Hospital, WA
Tania Cossich RN, MPH, Research Fellow, Deakin-Southern Health Nursing Research Centre,VIC
Paul N Bennett RN, PhD, Associate Professor, Deakin-Southern Health Nursing Research Centre,VIC
Steven Wright MBBS, FRACP,Visiting Nephrologist, Kalgoorlie, WA
Cherene Ockerby BA (Hons), Research Assistant, Deakin-Southern Health Nursing Research Centre,VIC
Correspondence to Ms Tania Cossich, Deakin-Southern Health Nursing Research Centre, Monash Medical Centre, Southern
Health, Clayton Road, Clayton,VIC, Australia Tania.Cossich@health.vic.gov.au

28 Renal Society of Australasia Journal // March 2013 Vol 9 No 1

 A nurse-managed kidney disease program in regional and remote Australia
1    

Figure  
Figure 11. .  M ap  oof
Map f  GGoldfields
oldfields  rregion,
egion,  Western
Western   Australia  
Australia and and  
majorm ajor   centres,  
centres, population  
population and  
and distances from Perth (Government of Western Australia, 2011)
distances  from  Perth(1).  
  and preparation for dialysis access
or transplantation
Distance were often required to attend services in Perth.
 
Major
Centres
Population From This involved frequent, long-distance travel as far
  Perth as 600 km from Kalgoorlie to Perth and 1500 km
Kalgoorlie 28,196 595km
Leonora 1,072
from Warburton to Perth. Aboriginal people who
Population 830km
Major Distance
Centres
Laverton 440
From Perth
954km undertook, and continue to undertake this travel, can
Kalgoorlie
Norseman
28,196
1,058
595km
721km suffer distress, isolation and dislocation from their
Leonora 1,072 830km
Esperance
Laverton
9,365
440
730km
954km
usual social supports and environment, and encounter
Ravensthorpe 348 540km services that may not be sensitive to cultural concerns
Norseman 1,058 721km
Esperance 9,365 730km (Jeffries-Stokes, Stokes, McDonald, Stokes & Daly,
Ravensthorpe 348 540km 2011).
Historically, specialty nephrology workforce deficits
have impaired the successful resourcing of CKD
services or long-term nursing programs to support
tertiary dialysis services and the dialysis centre at
Kalgoorlie Hospital (KH). This is despite past efforts
2  
of nephrologists, surgeons, vascular access nurses and
& McEldowney, 2012), and could further support nurse-led
CKD specialist nurses who conducted clinics in the Goldfields
management of Aboriginal patients with renal disease.
region. The lack of a coordinated, Kalgoorlie-based service
CKD in the Goldfields region of Western Australia was identified as a gap that needed to be addressed to provide
The prevalence of stage 3 and 4 CKD has been estimated to specialised kidney disease management while still embracing the
be 83,000 and 2,265 with stage 4 and 5 CKD, based on a state Aboriginal Health Service and local general medical practices.
population of approximately 755,000 people aged 45 years or Prior to program implementation, a Perth-based nephrologist
older (Western Australia Department of Health, 2008). In 2009 flew into KH to attend clinics on a weekly basis. Outside
the incidence of patients undergoing dialysis in WA reflected a these times, patients were managed at KH by medical staff in
nationwide stabilising trend (Grace, Excell, Dent & McDonald, consultation with Perth-based services. The use of KH as the
2008); however, previously reported linear projections predict base for the GKDNMP has enabled specialised renal nurses to
an annual increase of 6.3% (Western Australia Department of manage the program and work more closely with regional and
Health, 2008). This is a predicted increase from 330 people in remote Aboriginal communities. The nephrologist continues
2010 to 670 in 2021 (WACHS, 2010). to attend clinics at KH and remote areas, supported by
The Goldfields region is the largest of nine government regions videoconferencing facilities as needed.
in WA, with approximately 58,727 residents living in 10 major
regional towns and 17 remote Aboriginal communities (Figure Program development and implementation
1). Kalgoorlie is the largest town in the region, with remote The GKDNMP was designed to improve the care processes
communities loosely clustered around Kalgoorlie, and the and service delivery for people with, or at risk of, CKD living
towns of Leonora, Laverton, Warburton and Tjuntjuntjara. An in remote areas. The program used the framework developed by
1
estimated 8% of the regional population is of Aboriginal descent the WA Renal Disease Health Network to identify seven key
with a wide variance in the percentage of Aboriginal people action areas to improve renal health care services. The model
in these towns, including 9% in Kalgoorlie, 42% in Laverton, included prevention strategies; early detection and management
and 89% in Ngaanyatjarraku Shire. This is compared to three of patients with CKD; preparation and care of patients suitable
per cent population of Aboriginal descent for WA as a whole for kidney transplantation; end-of-life palliative care; appropriate
(Government of Western Australia, 2011). and timely nephrologist referrals and dialysis; establishment
The incidence and prevalence of CKD in the Goldfields of multidisciplinary clinics; and renal workforce development
region mirrors increases in the WA population. Projected (Western Australia Department of Health, 2008).
increases in the prevalence of kidney disease in WA justifies
the need to provide well-resourced programs to improve The Western Australian Country Health Services (WACHS)
renal health outcomes, renal services, and access to services for Renal Dialysis Plan Working Party refined the model in 2010
Aboriginal people to meet increasing demands and reduce the which informed the WACHS Renal Dialysis Plan 2010–2021
gap in renal health outcomes between Aboriginal and non- (WACHS, 2010). Recommendations to monitor the growth
Aboriginal Australians. This paper presents the development of the regional dialysis population, review and expand existing
and implementation of the Goldfields Kidney Disease Nursing satellite services, establish satellite outreach services, expand
Management Program (GKDNMP.) home dialysis services, develop services in new regional
locations, build workforce capacity, improve transport and
Service availability and acceptability accommodation, and information systems, formed the basis of
Past health care services for people with CKD in the Goldfields the federal government decision to increase funding for renal
region of WA were limited. People who required access to dialysis services in country WA (Swan, Roxon & Snowdon,
specialised nephrology services, CKD stage 3 and 4 education, 2011).

Renal Society of Australasia Journal // March 2013 Vol 9 No 1 29

A nurse-managed kidney disease program in regional and remote Australia

The COAG funding provided an opportunity to develop and and communities are supported with medication management,
implement the three-year GKDNMP with sensitivity to the diet, dialysis and education, and support with accommodation
needs of Aboriginal people and communities. The rationale for and transport needs to ensure patients attend clinics or
the development of the GKDNMP was the identification of treatments. Nurses have a unique skill set that enables the
a largely under-resourced CKD program, with limited staffing provision of a range of services to support patients across the
and service delivery resources for Aboriginal people in the care continuum. Effective management is underpinned by strong
Goldfields region (Western Australia Department of Health, relationships between patients and providers, characterised by
2008). The aim of the GKDNMP was to enhance existing good communication and trust (Wakerman et al., 2012). The
renal services within the Goldfields region by providing program engages a range of nursing roles to support this process
comprehensive prevention, health promotion, screening and and through strong nursing leadership, effective communication,
early identification, education, case management and tertiary team focus, and cultural sensitivity, Aboriginal communities have
care for Aboriginal people within the region. A particular focus been engaged and supported the program.
was given to improved access to renal services predominantly
provided by nurses in metropolitan CKD programs, through The benefit of this approach rests with the range of knowledge
delivery of culturally secure services developed in consultation and skills nurses are able to provide in working with Aboriginal
with Aboriginal communities and Aboriginal-controlled health people across the care continuum. Delays in staff recruitment
services in the Goldfields region (Government of Western and in the development of strategies and services, however,
Australia, 2010). were experienced from September 2010 to May 2011, partly
due to the availability and confirmation of funding. Despite the
Designed to be managed by nurses, the program employed a delays, the positions have been able to provide culturally secure,
clinical nurse manager, renal nurse educator, community renal accessible renal health care services and an appropriate system to
nurse, Aboriginal health workers (AHWs) and administrative support patients close to their home and social supports in the
officer. The program structure outlined in Figure 2 shows that remote Goldfields region. Moreover, the high level of skill and
the program team is managed by a specialist renal nurse who knowledge of the specialised staff enable nursing staff to backfill
functions as the program nurse manager. The nephrologist flies or accommodate positions for short periods of time, if required.
in and out of Kalgoorlie from Royal Perth Hospital (RPH) to
join the program team for clinics. The program provides patient Staff recruitment, culturally secure service provision, community
care across a number of sites. All staff are involved in renal clinics consultations, and the establishment and maintenance of
at KH and the remote clinics and Aboriginal communities. If effective partnerships have underpinned program development
the nephrologist is unable to fly into KH, videoconferencing and facilitated appropriate and effective care pathways and
facilities are used to support clinics at KH. Clinics at Bega communication protocols. These activities have been designed
Garnbirringu Health Service (BGHS), the Kalgoorlie-based to build on primary services and improve access and delivery of
Aboriginal-controlled clinic, are attended by the nephrologist primary, acute and subacute health care services.
and community renal nurse. The local Aboriginal communities
that are readily accessed by car from KH are seen by the Closing the Gap in Aboriginal health: GKDNMP
community renal nurse and AHW. development and implementation
The bulk of renal care provided by the program to Aboriginal The COAG National Partnership Agreements on Closing the
Figure
people 2. GKDNMP
is managed structure.
by the team based at KH. Aboriginal people Gap in Aboriginal health outcomes identified priority areas to

 Figure 2. GKDNMP structure.

PROGRAM  STAFFING   PROGRAM  SITES  
 

  Kalgoorlie  Hospital  
Program  Nurse  Manager  
    Remote  clinics  &  
Administration  assistant   Aboriginal  communities  
All  staff  
  Renal  nurse  educator  
Aboriginal  h ealth  worker   Local  Aboriginal  
    Communities  
Community  renal  nurse  
   
BGHS  
  Nephrologist  
  RPH  
 

30 RenalThe
Societybulk of renal
of Australasia care
Journal provided
// March 2013 Volby the
9 No 1 program to Aboriginal people is managed by the team

based at KH. Aboriginal people and communities are supported with medication management, diet,
A nurse-managed kidney disease program in regional and remote Australia

drive improvements (Australian Health Ministers’ Conference, Laverton. The importance of a consistent renal team attending
2006). GKDNMP development and implementation was these clinics is vital to increase trust and confidence and improve
linked to outputs in Table 1 with a focus on the priority areas attendance rates, to facilitate management of people in various
(Government of Western Australia, 2010). stages of CKD in more remote areas. Monthly outpatient
clinics at BGHS with a nephrologist and the community renal
Table 1: Key action areas and program outputs. (Adapted from Appendix C(2)).
nurse, and weekly multidisciplinary clinics at KH, successfully
Action areas Program outputs identified greater numbers of people at stages 3 to 5 CKD.
Fixing the gaps Health system Aboriginal Health Workers provided
Due to these changes, more people access CKD stage 4 pre-
and improving to coordinate and follow up care transitions. dialysis education, lifestyle education and anaemia management.
the patient Transport and accommodation support for rural Although the impacts of this activity cannot be measured at this
journey and remote patients and their families. early stage of the program, the logical impact of this activity
Provision of culturally secure services and practices will be the reduction in CKD progression to end-stage kidney
across the renal health system. disease requiring renal replacement therapy.
Facilitate access to acute and sub-acute care.
The community renal nurse role has contributed to increased
Primary health Provision of culturally secure primary health care
outpatient renal clinics and consultation at KH and reduced
care services service, including MBS-funded service.
that can deliver transfers to RPH. This has been achieved through engagement
Culturally secure, multi-disciplinary chronic
kidney disease management services to provide with Aboriginal communities to identify Aboriginal people
screening, education/promotion and management. who may be unable to attend clinics without support. Transport
Develop communication protocols and care and accommodation needs have been identified and these have
pathways to improve renal care coordination, then been arranged for people requiring these services. The
referral and recall. respectful manner in which program staff communicate and
Minimum service standards in place for all work with Aboriginal people has led to strong engagement
organisations providing care services for Aboriginal with Aboriginal communities and requests for additional visits
people.
in remote areas. The number of transfers to Perth has been
Partnerships Partnerships with other renal agencies / reduced as program nurses are able to monitor people living
stakeholders.
in Aboriginal communities more frequently. They are able to
Community Appropriate renal-related community consulations.
consultations undertake regular screening and assessments, improve the uptake
of early interventions by Aboriginal people, and provide services
Fixing the gaps and improving the patient journey at KH. In the first six months of the program, 36 patients who
The AHW role was considered vital to understand different would have previously travelled to Perth for CKD management
value systems and reduce barriers in the provision of CKD care were able to access services at KH.
with Aboriginal communities. The AHWs promote and develop Improved attendance rates led to a 100% increase in the
culturally secure services and practices, coordinate follow-up identification and management of people with CKD stage 5
care and transitions, arrange transport and accommodation, and (eGFR<15 ml/min), an increase from 38 to 76 people with
improve access to acute and subacute care. One male AHW stages 4 or 5 CKD. In the initial six months of the program,
was engaged for three months. The assistance and education there was a significant decrease in the number of patient
provided by the AHW contributed to a deeper understanding transfers and hospital admissions to RPH. This included two
of the impact of CKD for non-Aboriginal nursing staff, and the patients who were able to receive peritoneal dialysis tube
development of appropriate practices and procedures. insertion at KH, a procedure that had previously required
This was achieved by the AHW through education seminars transfer to RPH and an inpatient stay of two months post-
for health workers, contribution to the design of culturally procedure.
appropriate educational materials, and one-on-one education The GKDNMP arranged for increased support from the
regarding Aboriginal culture and sensitivities with KH Perth-based vascular access team, who now visit KH quarterly.
haemodialysis nursing staff. Staff feedback indicated seminars The GKDNMP assists the vascular access team by providing
were valuable for informing their nursing care with Aboriginal appropriate communication and education, and arranges patient
patients undergoing dialysis. Importantly, the AHW informally transport to encourage attendance. Attendance rates have
engaged and supported patients during each shift in the dialysis doubled in the first six months of the program. This is likely
unit. He successfully contributed to decreased patient transfers to improve the number of people who require dialysis with
from the Goldfields region to Perth, reduced patient distress, adequate preparation in managing their vascular access.
reduced negative impacts of relocation, increased dialysis
Access to acute services also increased in the first six months
attendance rates, and decreased the accommodation and travel
of the program. Dialysis patients with acute complications are
costs of temporary relocation.
now managed by the GKDNMP in Kalgoorlie when clinically
As a result of this program, access to subacute services has appropriate. These conditions include acute fluid overload,
improved in the more remote parts of the Goldfields region. peritonitis and access issues, which previously required patient
Renal outreach clinics are now held quarterly at Warburton and transfers to a tertiary facility in Perth using the Royal Flying

Renal Society of Australasia Journal // March 2013 Vol 9 No 1 31

A nurse-managed kidney disease program in regional and remote Australia

Doctors Service. Again, this has contributed to decreased Ongoing education has increased the capacity of GPs and
unnecessary transfers to Perth. practice nurses to provide services such as targeted screening
and minimisation of modifiable risk factors for CKD. This
In the event that travel to Perth is unavoidable, established care education has improved clinicians’ confidence and knowledge,
plans and clinical support enable patients to remain in their local and strengthened relationships between GKDNMP staff, GPs
community until the point of transfer. For example, patients and practices nurses. This has resulted in increased attendance
requiring home haemodialysis training can be supported at rates at the Aboriginal Health Service rather than KH, in line
home until transfer for haemodialysis is required. This has with patient preferences.
reduced inpatient admissions in Perth from an average of
three weeks to one week and lengths of stay have decreased Partnerships
through collaborative community health care, for example,
The need to foster relationships and develop partnerships
intraperitoneal antibiotics administered remotely through
with renal-related agencies and stakeholders in order to close
collaboration with GKDNMP. Liaison with dialysis patients and
the gap has been recognised by the GKDNMP. During the
families has seen attendance rates improve from 50% to 90%
program’s initial six months, a collaborative, problem-solving
over a six-month period for dialysis patients in Kalgoorlie.
approach focused on patient case management was used to
Delivering primary health care services develop working relationships with local and outreach health
facilities. The partnership and collaborative relationship, together
Primary health care has a significant role in the early detection with improved education, and clearer patient pathways, have
and management of people with CKD. Primary health care contributed to improved patient care and reduced travel to both
responsibilities require the GKDNMP to support other services Kalgoorlie and Perth.
to improve the access to health care services for people with
CKD. Significant progress in this area has seen a range of health GKDNMP staff are actively involved in two of the four
promotion activities to raise awareness and engage communities working groups formed to promote remote renal services, the
in screening and education for populations at risk of CKD, and Haemodialysis Model of Care, and Community Engagement
rural and remote health workers. Awareness-raising activities and Health Promotion. Strong partnerships and collaboration
have included World Kidney Day, where education and with the RPH, WACHS, Fresenius Medical Care (a home
screening was offered to the public. Over 50% of the 19 people dialysis care provider), KH, Ngaanyatjarra Health Service,
screened had hypertension and were advised to see their general and Western Desert Nganampa Walytja Palyantjaku Tjutaku
practitioner (GP) as soon as possible. Results indicate five people (WDNWPT) have been vital to providing the best in culturally
contacted the service for ongoing CKD support and education, sensitive, coordinated renal care.
an additional six agreed to a visit from the community renal
Effective collaboration with a range of staff from the above
nurse, and three attended the BGHS outpatient clinic.
services has led to a number of key achievements. The most
CKD screening and education promotion activities in notable development has been a referral pathway with
Kalgoorlie and more remote areas of the Goldfields region Ngaanyatjarra Lands and review form. It has led to improved
have been led by the community renal nurse and GKDNMP referral and communication pathways between Kalgoorlie,
team in collaboration with Kidney Health Australia (KHA). Ngaanyatjarra Lands, Fresenius Medical Care (FMC) and
In the six months to April 2011, five renal education sessions tertiary facilities such as RPH, regarding discharge processes for
were delivered to health care providers at Laverton Hospital, Aboriginal patients returning to Warburton and surrounding
Warburton Clinic, KH and the Edward Collick Nursing Home. areas. In addition, a home dialysis discharge and referral protocol
Remote clinic nurses reported improved skills, knowledge and review form was developed between the Goldfields region
and confidence regarding when to refer to other services, and FMC.
particularly for patients receiving peritoneal dialysis.
Further collaboration has led to improved coordination
Liaison with GP network programs such as the “Heart and care delivery closer to Goldfields renal patients’ homes
Moves Program” (Heart Foundation, 2011) contributed to in Ngaanyatjarra Lands. The Ngaanyatjarra Health Service,
overall improvements in services aimed to decrease CKD and WDNWPT, BGHS, and GKDNMP have been proactive
cardiovascular disease risk factors, and a structured approach in developing proposals for dialysis services at Warburton
to CKD pathology specimen collection. The GP Network Hospital and BGHS health clinic to further reduce the need for
sponsored the Kidney Check Australia Taskforce (KCAT) relocation for dialysis services and address cultural sensitivities.
managed by KHA to provide workshops targeted for practice Development of the BGHS dialysis service has the potential to
nurses and GPs. Using a series of education modules, the provide a supported, self-care dialysis service and decrease the
interactive learning sessions, with national accreditation and need of some patients to attend KH.
continuing education points, aim to improve the knowledge,
detection and management of kidney disease in general practice Community consultations
(Kidney Health Australia, 2011). Prior to the GKDNMP, A feature of the GKDNMP has been an increased number and
facilitation of these programs targeting the appropriate health improved quality of community consultations. These have been
care services had been limited. held with a range of established Aboriginal-controlled health

32 Renal Society of Australasia Journal // March 2013 Vol 9 No 1

A nurse-managed kidney disease program in regional and remote Australia

services and council meetings with community elders. These Development of an NP role would further enable program
groups contributed to the development and implementation support and can improve patient outcomes (Wakerman et al.,
phase of the project and continue to inform changes using a 2012). This role would need to be carefully scoped as it would
continuous quality improvement approach. This will include require specialised renal and Aboriginal health knowledge
ongoing development of culturally relevant renal resources.
and not be limited to clinical perspectives. That is, the role
Non-Aboriginal groups have contributed to health promotion needs to be developed with the ability to influence the social
activities such as World Kidney Day. Public events were determinants of health (Cerasa, 2011).
used to provide public education and screening initiatives in
collaboration with Watercorp, Leonards Chicken Supply, and Limitations
the Oasis Centre for Kidney Week. High attendance rates at
education and screening days held in the community, and The quality of the program in relation to the acceptability from
continuity of a collaborative, problem-solving approach to the Aboriginal communities has not been directly addressed.
patient-centred care, have strengthened existing relationships This information has been identified anecdotally but a more
with WACHS Health Services Providers, Tjuntjuntjara, rigorous approach undertaken with cultural sensitivity would be
Warburton and Laverton in outlying areas. valuable.

Discussion Conclusion
Establishment of the GKDNMP has improved culturally
The GKDNMP has achieved significant success in the majority
secure renal health programs and access to health services for
of the 10 COAG outputs and improved access and delivery of
Aboriginal people at risk of, or with, CKD. This has been
achieved by staff awareness and commitment to deliver the right culturally secure renal health care services. The commitment to
care at the right place, and avoid unnecessary relocation to larger improve the prevention of, and services for, people with CKD, is
centres such as Kalgoorlie and Perth that results in immeasurable, evident from the WACHS Goldfields Regional Director through
negative personal, family and health impacts. to the renal program staff, with nursing roles central to the
Program staff have improved access and culturally relevant support and sustainability of these changes. This commitment
services for patients and families, and improved staff confidence has been demonstrated through substantial progress in only eight
and understanding of culturally and renal-specific knowledge months. This early progress report has summarised many of these
and skills. An initial challenge in recruiting AHWs provided achievements and provided suggested opportunities to continue
opportunities to identify alternative methods to recruit to this program to contribute to closing the gap in renal health-
this role, and emphasised the need to provide support and related outputs in the WACHS Goldfields region.
clarification during the early stages of the role. Recruitment
could be achieved through BGHS, local communities, dialysis Nursing has a strong role in improved access and delivery of renal
patients, or transplant recipients. Mentorship programs using health services in remote Aboriginal communities in Australia.
successful renal AHWs from other areas, such as Kimberly, Alice The program demonstrates the strong ability nursing has to
Springs, or Perth could be considered to provide additional improve Aboriginal health, and while improvements in renal
support.
health outcomes may not be noted for some time, the strong
In the limited time the program has been operational, significant relationships built with Aboriginal people and communities will
improvements in health service delivery to Aboriginal support changes in the longer term.
communities have been achieved. This has been demonstrated
through requests from Aboriginal communities for increased References
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PBS Information: Authority required (STREAMLINED). Refer to PBS Schedule for full authority information.
Please review full Product Information before prescribing.
Full Product Information is available from Sanofi.
Minimum Product Information. RENAGEL® (Sevelamer Hydrochloride). Indication(s): the management of
hyperphosphataemia in adult patients with stage 4 and 5 chronic kidney disease. Contraindication(s): hypophosphataemia or
bowel obstruction and known hypersensitivity to sevelamer hydrochloride or any of the other components of the tablet. Precautions:
in patients with dysphagia, swallowing disorders, severe gastrointestinal (GI) motility disorders, severe constipation or major GI tract
surgery. Patients with renal insufficiency may develop hypocalcaemia or hypercalcaemia. Patients with chronic kidney disease are
predisposed to metabolic acidosis. Adverse Events: headache, infection, pain, hypotension, hypertension, thrombosis, diarrhoea,
dyspepsia, vomiting, cough increased, nausea, dyspepsia,constipation, nasopharyngitis, bronchitis, upper respiratory tract infection, pain
in limb, arthralgia, back pain, pruritus, dyspnoea, cough,hypertension, mechanical complications of implant, pyrexia, flatulence, rash and
abdominal pain. In very rare cases, intestinal obstruction and ileus/subileus. Interactions: RENAGEL should not be taken simultaneously
with ciprofloxacin, very rare cases of increased TSH levels have been reported in patients co-administered RENAGEL and levothyroxine,
special precautions should be taken when prescribing RENAGEL to patients also taking anti-arrhythmic and anti-seizure medications.
Dosage: RENAGEL (sevelamer hydrochloride) 800 mg tablets. The recommended starting dose for patients not taking a phosphate
binder is 800 to 1600 mg, which can be administered as one to two RENAGEL tablets with each meal based on serum phosphate level.
When patients are converting from a calcium based phosphate binder, RENAGEL should be given in equivalent doses on a (mg to mg)
weight basis compared to the patient’s previous calcium based phosphate binder. The dosage should be gradually adjusted based on
the serum phosphate concentration with a goal of lowering serum phosphate.The dose may be increased or decreased by one tablet per
meal at two week intervals as necessary. Patients should be advised not to chew the tablets as sevelamer hydrochloride swells on contact
with moisture. Patients should swallow the tablets whole with water. PBS dispensed prices: $357.73. Renagel® (Sevelamer hydrochloride)
TGA Approved Product Information 13th October 2008. Renagel® is a registered trademark of Genzyme Corporation USA. sanofi-
aventis australia pty ltd trading as Sanofi ABN 31 008 558 807, Talavera Corporate Centre, Building
D, 12-24 Talavera Road, Macquarie Park, NSW 2113. AU.SEV.11.12.003.

34 Renal Society of Australasia Journal // March 2013 Vol 9 No 1