Supporting equitable access to kidney transplant in remote Western Australia using continuous quality improvement

Abstract

Background: Despite an epidemic of end-stage kidney disease in the Australian Aboriginal and Torres Strait Islander population, disparities in access to kidney transplantation persist. The journey to a successful kidney transplant is long, with an initial suitability assessment required before waitlist-specific activities begin. In an Aboriginal Community Controlled renal service, we aimed to: (i) design and implement a continuous quality improvement (CQI) approach to transplant suitability assessment, (ii) provide transplant suitability assessments for all patients of the service, (iii) describe what temporary contraindications to kidney transplantation should be the focus of health service improvements, (iv) explore participant experiences with the suitability assessment process, and (v) use our findings to inform pre- and post-transplant model of care development within Kimberley Renal Services.

Methods: Mixed methods design with file review. Transplant suitability assessment results with descriptive analysis and semi-structured interview with thematic analysis.

Results: Of completed assessments, 20/66 (30%) had no contraindications and were cleared for workup with median time on dialysis prior to assessment of 2.9 years, 42/66 (64%) had temporary contraindications, and 4/66 (6%) had permanent contraindications. Eighty-five temporary contraindications were identified in 46 individuals: 17/46 had both medical and nonmedical contraindications, 5/46 had medical contraindications only, and 24/46 had nonmedical contraindications only. The most common temporary contraindications were smoking (23/46), treatment adherence (17/46), and high body mass index (11/46). Patients wanted more information on the transplant process, and interviewers noted the importance of providing information in an appropriate way. Patients wanted more support to address modifiable health risk factors to improve their chances of future transplantation.

Conclusions: In the first stages of our CQI approach to improving access to kidney transplants for Kimberley Aboriginal people, we achieved substantial catch-up in suitability assessments and a comprehensive summary of factors impacting successful waitlisting. Our results are consistent with, and build upon other work in this space, highlighting the importance of involving Aboriginal staff and patients in education and support for prospective recipients.

Keywords: Aboriginal health; CQI; equity; kidney transplant; renal.

Figure 1

CQI framework for transplant suitability assessment.

Figure 2

Inclusion and exclusion criteria, with assessment outcome for included patients.