ASN 2010: How Can We Reduce Racial Disparities in CKD and Diabetes?

Evidence-based strategies can alleviate gaps in providers' knowledge of chronic kidney disease and diabetes in underserved patient populations.

Knowledge deficits need not block proper preventative care for community members who collaboratively seek to reduce diabetes incidence, or family physicians that need a leg up in the incorporation of minimum practice guidelines for chronic kidney disease (CKD) treatment, according to physicians speaking in Denver, CO, Thursday at Renal Week 2010, the 43rd Annual Meeting and Scientific Exposition of the American Society of Nephrology (ASN).

In two symposia presentations, titled “Making Chronic Kidney Disease Guidelines Work in Underserved Practices” and “Promising Community Health Worker-Led Strategies for Reducing Disparities in Diabetes and its Complications,” presenters reviewed several issues that challenge providers and patients alike in regions where racial disparities exacerbate exposure to kidney disease and kidney-related maladies.

Chester Fox, MD, a family physician working in Buffalo, NY, reminded the audience that CKD is four times more likely to burden minority populations. He recounted his experience with a study that employed participatory research to evaluate those provider- and staff-identified barriers which stifle implementation of evidence-based guidelines for minority CKD treatment at family practices.

Fox said that a qualitative study conducted during 2005 and 2006 by the eight-county Upstate New York Practice-based Research Network showed that the National Kidney Foundation Kidney Disease Outcomes Quality Initiative Guidelines (NKF KDOQI) for clinical practice in renal care were not at all well known among family doctors. “We found that only 10% of the physicians were even aware of the guidelines that I’ve talked about nationally,” he told an ASN luncheon session. This finding was later confirmed by a second national study.

“The specialist can’t understand why we in primary care don’t take the two minutes or three minutes it would take to add these guidelines and to know about other things,” Fox said. “The thing for us in primary care is that we have 300 of these two- or three-minute things that we’re expected to do. We have a bunch of competing demands.”

To address the minimum care knowledge gap, Fox and his colleagues implemented a system of practice enhancement associates (PEAs), whereby research assistants develop a registry to guide evidence-based CKD alerts for primary care physicians, which the family doctor can then choose to accept, reject, or modify. The PEAs were “readily accepted,” Fox said, and continue to stand as a model for community-based point-of-care guidance in CKD therapy.

On the patient side, community-based participatory research (CBPR) efforts have for several years driven progress within the REACH Detroit Partnership, a network of planned interventions aimed at preventing type 2 diabetes within Latino and African American communities located in the city of Detroit.

The initiative is organized along the lines of facilitators who work at the family, community, health system, and social group levels. In these areas, workers and health advocates strive to promote healthy eating habits, diabetes self-management, access to exercise facilities, reduced behavioral risks, and improved provider-patient relationships.

“Capacity building and community benefits are the congregations of CBPR,” said Project Manager Gloria Palmisano. “Partners share responsibility, expertise and ownership for planning and conducting outcomes of the research, as well as disseminating results.”

As part of this effort, Palmisano has developed a comprehensive training program for community health workers, and positioned REACH staff in additional local, regional, state, and national efforts related to the REACH Detroit objectives.