Effectiveness, cost effectiveness, acceptability and implementation barriers/facilitators of chronic kidney disease management programs and models of care for Aboriginal and Torres Strait Islander Australians: a mixed methods systematic review protocol

Abstract

Review objectives and questions: The objective of this mixed methods review is to synthesize quantitative, economic and qualitative evidence on chronic kidney disease management programs and models delivered to Aboriginal and Torres Strait Islander Australians. Studies with Indigenous participants from New Zealand and Canada will also be considered because similar persistent patterns of health inequities have arisen in these countries as a result of a shared colonial history, despite vast differences in timing and location. Also, there are geographic and demographic similarities, such as remoteness from health services and poor engagement due to differing language, culture and concepts of health and illness from the dominant culture. These socio-demographic circumstances are associated with higher burdens of chronic disease and poorer health outcomes. The intention of this systematic review is to inform chronic kidney disease program design, practice and service delivery to Aboriginal and Torres Strait Islander populations in Australia. The questions to be addressed in the review are: 1. What is the effectiveness of programs/models in relation to outcomes, including, though not limited to, the management of “indicators to target” such as blood pressure control, the delayed progression of kidney disease/time to dialysis, and quality of life? 2. What are the costs and costs relative to benefits of the programs/models from the perspectives of individual patients and their families, the primary health services that deliver them, tertiary health services and society as a whole? 3. What do patient and provider experiences of programs/models reveal about the acceptability of programs, as well as barriers and enablers of implementation?