Report cites health inequity, disconnect with primary care as barriers for treating CKD
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A new report from the Milken Institute recommends that health officials prioritize identification of the root causes of health inequity that contribute to kidney disease in efforts to slow down its occurrence.
“Tackling this public health issue requires a whole-of-society effort, and in this report, we call on policymakers (federal, state and local), government agencies, health care administrators, health care providers, allied health professionals, payers, members of the community and community-based organizations (CBOs) to assume leadership and supporting roles and to collaborate with intention and urgency across public health, health delivery and nontraditional health sectors,” Sarah Wells Kocsis, MBA, director of the Milken Institute’s Center for Public Health and colleagues wrote in the report.
Other top priorities identified by the report include the need for improvement in nutritional services for patients with CKD; changes to the infrastructure in primary care; a greater focus on preventive screening; recognition of the importance of education, health communication and literacy; greater availability of telehealth services; accountability in care and the advancement of value-based care.
“By shedding light on the growing public health issue of CKD and better understanding these areas and their intersection with CKD, we can identify strategies to help address and reduce the burden of CKD in the United States,” the authors wrote.
Primary care
The report places an emphasis on the need for primary care physicians to be more involved in early detection of kidney disease.
“To further this vision of finding a path to prevention, earlier detection and management of CKD, a robust public health and primary care infrastructure must be established, clinical practices as well as nutritional services must be augmented and streamlined, CBOs must be called upon, and individual community members must be educated and heard,” Wells Kocsis and colleagues wrote.
“To better negate the rise in CKD prevalence, CKD prevention initiatives must be adequately funded, health care and public health workforce shortages must be addressed and the health care system must shift its focus from disease-centered treatment to person-centered care by implementing value-based care models,” they wrote. “Additionally, all efforts must consider health equity and the social determinants of health to reach the under-resourced populations that are most vulnerable to this debilitating disease.”
Large population
The authors outline 40 action steps for improving care for patients with CKD based on the sheer number of individuals who could benefit from early and aggressive treatment, including the increasing number of patients with diabetes.
“In the United States, the rapid increase in the number of adults with type II diabetes and obesity has reached epidemic proportions,” the authors wrote. “These preventable chronic conditions and the aging of the U.S. population, combined with the effects of COVID-19 such as increased diabetes risk, kidney injury and disruptions in access to health care, are having a significant impact on the prevalence of kidney disease in the country.
“The devastating health consequences of CKD and the historically high prevalence of the disease in its early stages necessitate the development and implementation of public health strategies that facilitate prevention, earlier disease detection and management to prevent its complications and progression to kidney failure,” they continued.
The authors cite some positive steps aimed at improving CKD care, but write more work needs to be done.
“Despite the challenges faced by people at risk for CKD and by health care providers, the recent interest, funding, and innovation in the CKD space show promising signs that, with the appropriate resources, tools and incentives, the field can transform its approach to identification and management of the disease through a focused and sustained push toward prevention, earlier detection and holistic, person-centered management,” the authors wrote. To improve access to individualized care, “federal funding mechanisms for CKD promotion, prevention and surveillance must be created at the federal, state and local levels; clinical practices must be augmented and streamlined; CBOs must be engaged and individual community members must be educated and heard,” the authors wrote in the report’s conclusions. “Additionally, all efforts must consider health equity and the social determinants of health to reach the under-resourced populations that are most vulnerable to this debilitating disease.
“Further, effectively curbing the ever-increasing rates of CKD requires implementing these efforts now,” the authors concluded.
Reference:
Kocsis SW, et al. Chronic Kidney Disease: Path to Prevention, Earlier Detection, and Management. https://milkeninstitute.org/report/chronic-kidney-disease-prevention-detection-management. Published June 30, 2022. Accessed August 31, 2022.
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