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Comparative Study
. 2012 Feb;58(2):e107-11.

Management of aboriginal and nonaboriginal people with chronic kidney disease in Quebec: quality-of-care indicators

Jason Michael Patapas  1 , Ana Chelene Blanchard, Sameena Iqbal, Murray Vasilevsky, David Dannenbaum
Affiliations
Comparative Study

Management of aboriginal and nonaboriginal people with chronic kidney disease in Quebec: quality-of-care indicators

Jason Michael Patapas et al. Can Fam Physician. 2012 Feb.

Abstract
in English, French

Objective: To compare quality-of-care indicators for management of patients with chronic kidney disease (CKD) and type 2 diabetes among the James Bay Cree of Northern Quebec with those among residents of Montreal, Que.

Design: A cross-sectional survey using medical records from patients seen between 2002 and 2008.

Setting: Predialysis clinics of the McGill University Health Centre in Montreal.

Participants: Thirty Cree and 51 nonaboriginal patients older than 18 years of age with type 2 diabetes mellitus and estimated glomerular filtration rates of less than 60 mL/min/1.73 m2.

Main outcome measures: Rates of anemia, iron deficiency, obesity, and renoprotective medication use among aboriginal and nonaboriginal patients.

Results: Overall, the Cree patients were younger (59 vs 68 years of age, P < .0035) and weighed more (101 vs 77 kg,P < .001). The 2 groups were prescribed medication to control blood pressure, lipids, and phosphate levels at similar rates, but the Cree patients were more likely to receive renoprotective agents (87% vs 65%, P = .04). Despite similar rates of erythropoietin supplementation, the Cree patients were at greater risk of anemia, with an adjusted risk ratio of 2.80 (95% CI 1.01 to 7.87).

Conclusion: Cree patients with CKD were younger, weighed more, and were more likely to receive renoprotective agents. With the exception of the management of anemia, quality of CKD care was similar between the 2 groups.Anemia education for family physicians and continuous monitoring of quality indicators must be implemented in northern Quebec.

Objectif: Comparer les indices de qualité pour le traitement des malades souffrant de maladie rénale chronique (MRC) et de diabète de type 2 chez les Cris de la Baie James du Nord du Québec par rapport aux malades vivant à Montréal, Qué.

Type d’étude: Enquête transversale à partir des dossiers médicaux des patients ayant consulté entre 2002 et 2008.

Contexte: Cliniques de prédialyse du centre de santé de l’Université McGill à Montréal.

Participants: Trente Cris et 51 patients non-Autochtones de plus de 18 ans souffrant de diabète de type 2 et ayant un taux de filtration glomérulaire estimé à moins de 60 mL/min/1,73 m2.

Principaux paramètres à l’étude: Taux d’anémie, de déficience en fer, d’obésité et de prise d’agents de protection rénale chez les Autochtones par rapport aux patients non autochtones.

Résultats: Dans l’ensemble, les patients Cris étaient plus jeunes (59 c. 68 ans, P < ,0035) et plus lourds (101 c. 77 kg, P < ,001). Les 2 groupes prenaient, à des taux comparables, des médicaments pour contrôler la tension artérielle et les niveaux des lipides et de phosphate, mais les Cris étaient plus susceptibles de prendre des agents de protection rénale (87 % c. 65 %, P = ,04). Même s’ils recevaient des suppléments d’érythropoïétine à des taux semblables, les Cris étaient plus à risque d’anémie, leur taux de risque ajusté s’élevant à 2,80 (IC à 95 % 1,01 à 7,87).

Conclusion: Les patients cris souffrant de MRC étaient plus jeunes et plus lourds, et ils étaient plus susceptibles de prendre des agents de protection rénale. Sauf pour le traitement de l’anémie, la qualité du traitement de la MRC était semblable dans les 2 groupes. Il y a lieu d’instaurer des séances de formation sur l’anémie pour les médecins de famille et une surveillance continue des indices de qualité dans le Nord du Québec.

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