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Wong G, Guha C, Mallitt KA, van Zwieten A, Khalid R, Francis A, Jaure A, Kim S, Teixeira-Pinto A, Aquino M, Bernier-Jean A, Johnson DW, Hahn D, Reidlinger D, Ryan EG, Mackie F, McCarthy H, Varghese J, Kiriwandeniya C, Howard K, Larkins N, Macauley L, Walker A, Howell M, Caldwell P, Woodleigh R, Jesudason S, Carter S, Kennedy S, Alexander S, McTaggart S, Craig JC, Hawley CM. The randomized controlled trial (NAVKIDS2) of a patient navigator program created for children with chronic kidney disease. Kidney Int 2024:S0085-2538(24)00450-2. [PMID: 38959996 DOI: 10.1016/j.kint.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/25/2024] [Accepted: 05/30/2024] [Indexed: 07/05/2024]
Abstract
Patient navigators enable adult patients to circumnavigate complex health systems, improving access to health care and outcomes. Here, we aimed to evaluate the effects of a patient navigation program in children with chronic kidney disease (CKD). In this multi-center, randomized controlled trial, we randomly assigned children (aged 0-16 years) with CKD stages 1-5 (including children on dialysis or with kidney transplants), from low socioeconomic status backgrounds, and/or residing in remote areas, to receive patient navigation at randomization (immediate) or at six months (waitlist). The primary outcome was self-rated health (SRH) of participating children at six months, using intention to treat analysis. Secondary outcomes included caregivers' SRH and satisfaction with health care, children's quality of life, hospitalizations, and missed school days. Repeated measures of the primary outcome from baseline to six months were analyzed using cumulative logit mixed effects models. Semi-structured interviews were thematically evaluated. Of 398 screened children, 162 were randomized (80 immediate and 82 waitlist); mean age (standard deviation) of 8.8 (4.8) years with 64.8% male. SRH was not significantly different between the immediate and wait-listed groups at six months. There were also no differences across all secondary outcomes between the two groups. Caregivers' perspectives were reflected in seven themes: easing mental strain, facilitating care coordination, strengthening capacity to provide care, reinforcing care collaborations, alleviating family tensions, inability to build rapport and unnecessary support. Thus, in children with CKD, self-rated health may not improve in response to a navigator program, but caregivers gained skills related to providing and accessing care.
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Affiliation(s)
- Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Kylie-Ann Mallitt
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anita van Zwieten
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Rabia Khalid
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, New South Wales, Australia
| | - Anna Francis
- Child and Adolescent Renal Services, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Allison Jaure
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Siah Kim
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Martha Aquino
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Amelie Bernier-Jean
- CIUSSS du Nord-de-l'Île de Montréal, University of Montréal, Montreal, Canada
| | - David W Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia; Translational Research Institute, Brisbane, Queensland, Australia
| | - Deirdre Hahn
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Donna Reidlinger
- Translational Research Institute, Brisbane, Queensland, Australia; The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth G Ryan
- QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Fiona Mackie
- Department of Nephrology, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
| | - Hugh McCarthy
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Julie Varghese
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Charani Kiriwandeniya
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Kirsten Howard
- Menzies Centre for Health Policy and Economics and Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Larkins
- Department of Nephrology, Perth Children's Hospital, Perth, Western Australia, Australia; School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | | | - Amanda Walker
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Menzies Centre for Health Policy and Economics and Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Patrina Caldwell
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Reginald Woodleigh
- Prostate and Breast Cancer Foundation (CanCare), Sydney, New South Wales, Australia
| | - Shilpa Jesudason
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Simon Carter
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sean Kennedy
- Department of Nephrology, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Steve McTaggart
- Child and Adolescent Renal Services, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | - Carmel M Hawley
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia; Translational Research Institute, Brisbane, Queensland, Australia; The University of Queensland, Brisbane, Queensland, Australia
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Kalantar-Zadeh K, Li PKT, Tantisattamo E, Kumaraswami L, Liakopoulos V, Lui SF, Ulasi I, Andreoli S, Balducci A, Dupuis S, Harris T, Hradsky A, Knight R, Kumar S, Ng M, Poidevin A, Saadi G, Tong A. World Kidney Day 2021: Living Well With Kidney Disease by Patient and Care Partner Empowerment-Kidney Health for Everyone Everywhere. Am J Kidney Dis 2021; 77:474-477. [PMID: 33589287 DOI: 10.1053/j.ajkd.2021.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/07/2021] [Indexed: 01/12/2023]
Affiliation(s)
- Kamyar Kalantar-Zadeh
- The International Federation of Kidney Foundations - World Kidney Alliance (IFKF-WKA), Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, CA; Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, CA.
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol & Richard Yu PD Research Centre, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong.
| | - Ekamol Tantisattamo
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, CA
| | | | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Siu-Fai Lui
- Hong Kong Kidney Foundation and the International Federation of Kidney Foundations - World Kidney Alliance, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Ifeoma Ulasi
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Sharon Andreoli
- James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Tess Harris
- Polycystic Kidney Disease Charity, London, United Kingdom
| | | | | | | | - Maggie Ng
- Hong Kong Kideny Foundation, Hong Kong, China
| | | | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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