Article type
Year
Abstract
Introduction: There is RCT evidence in diabetic and non diabetic renal disease that angiotension converting enzyme inhibitors (ACEi) have a specific renal sparing effect in addition to their systemic vasoactive effect. However, assessing efficacy of such evidence based medicine is particularity challenging in a setting of isolation, poor compliance, socioeconomic disadvantage, serious alcohol abuse, substandard living conditions, poorly developed health education and deficit chronic disease management. It becomes essential to incorporate "The Measurement Iterative Loop" (Tugwell et al) to evaluate efficiency, monitor the intervention, and re-asses the situation of the full circle.
Objective: In a survey of an Australian Aboriginal community of 1,100 people with a 60-fold elevation in renal failure rates, 30% of adults (18+years) were overweight (BMI>25kg/m2), 18% were diabetic, 11% had impaired glucose tolerance, 26% were hypertensive (BP>140/90), 25% had microalbuminuria (urine albumin/ creatinine ratio (ACR) 3.4 to 34 gm/mole), and 30% had overt albuminuria (ACR>34).
Methods: A five-year treatment program with the long-lasting ACEi perindopril, (Coversyl, Servier Labs) to retard the progression of renal and cardiovascular disease has been initiated. In this prospective community treatment program, process and outcome measures are systematic, compliance evaluated, costs calculated and adverse events evaluated.
Discussion: This presentation will focus on challenges specific to Aboriginal populations and the relevance of the Measurement Iterative Loop. Difficulties of compliance are reduced by the long-lasting, once-a-day dosing of perindopril. Limitation to primarily one ACEi agent provides uniformity for the community. Partnership with community councils and health workers ensures the program is culturally appropriate. Visit attendance is facilitated using "target dates" generated by computerised scheduling. Compliance is assessed by pill counts, specific questioning at each visit and biannual assessment of ACE levels. This study will provide information for the "Implications for Practice", allowing for a broader range of populations to contribute to the Cochrane Initiative.
Objective: In a survey of an Australian Aboriginal community of 1,100 people with a 60-fold elevation in renal failure rates, 30% of adults (18+years) were overweight (BMI>25kg/m2), 18% were diabetic, 11% had impaired glucose tolerance, 26% were hypertensive (BP>140/90), 25% had microalbuminuria (urine albumin/ creatinine ratio (ACR) 3.4 to 34 gm/mole), and 30% had overt albuminuria (ACR>34).
Methods: A five-year treatment program with the long-lasting ACEi perindopril, (Coversyl, Servier Labs) to retard the progression of renal and cardiovascular disease has been initiated. In this prospective community treatment program, process and outcome measures are systematic, compliance evaluated, costs calculated and adverse events evaluated.
Discussion: This presentation will focus on challenges specific to Aboriginal populations and the relevance of the Measurement Iterative Loop. Difficulties of compliance are reduced by the long-lasting, once-a-day dosing of perindopril. Limitation to primarily one ACEi agent provides uniformity for the community. Partnership with community councils and health workers ensures the program is culturally appropriate. Visit attendance is facilitated using "target dates" generated by computerised scheduling. Compliance is assessed by pill counts, specific questioning at each visit and biannual assessment of ACE levels. This study will provide information for the "Implications for Practice", allowing for a broader range of populations to contribute to the Cochrane Initiative.