Rural-based individuals in Canada face many health disparities. Several factors contribute to their disproportional exposure of rural areas to adverse health conditions, including the lack of financial resources and geographical problems. Chronic kidney disease (CKD) is a life-threatening but treatable disease affecting many Canadians in the rural setting. The high morbidity and mortality associated with CKD are related to rural and remote access to renal dialysis. Most patients are exempted from this vital and life-saving procedure due to inadequate financial resources and geographical barriers. Existing policies have focused on less effective methods such as the Satellite Hemodialysis (SHD). The SHD is a facility-based strategy delivered remotely under the supervision of a nephrologist. However, due to the lack of nephrologists at the center coupled with cost issues, the solution does not apply to rural Canadians. A more elaborated method, such as establishing remote and mobile dialysis centers in rural areas, would work. The policy will require the collaborative input of the government, citizens, and healthcare officials. More importantly, through the ministry of health, the government authorities will work to resolve the problem of nephrologist shortage.
Context and Importance of the Problem
Individuals living in rural and remote areas in Canada have a higher burden of chronic kidney disease (CKD) than the general population. Indigenous populations living in these areas have a higher chance of developing kidney failure. As illustrated by the authors, "Individuals living in isolated areas are disproportionately faced with social inequalities such as poverty and poor access to services" (Harasemiw, Milks, Oakley, Lavallee, Chartrand, McLeod, & Komenda, 2018). Patients with CKD suffer from the risk of early disability and death. Patients in rural areas frequently require relocation to receive the much-needed hemodialysis. The indigenous Canadians are mostly affected by this issue. The lack of access to kidney dialysis services means that patients in rural areas suffer a disproportional risk of early death. The most affected populations are situated in Manitoba, Alberta, and the Northern-based communities. Besides the geographical implications associated with the disparity, cost also plays a significant role (Ferguson, Zacharias, Walker, Collister, Rigatto, Tangri, & Komenda, 2015). Current and existing policies have also failed to meet the needs of the rural-based populations.
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Critique of the Policy Options
The government in Canada and neighboring countries such as the United States has several strategies to avail dialysis services for rural populations. One of the options that have received significant attention is known as the Satellite Hemodialysis (SHD). The SHD is a facility-based strategy delivered remotely under the supervision of a nephrologist. The nephrologist is mainly located at a regional tertiary center (Ferguson et al., 2015). However, this strategy has continually faced several fundamental problems. First, the lack of a nephrologist at the contact site could result in poor outcomes. Stakeholders have also reported the cost implications associated with the SHD. As illustrated by the authors, "Satellite hemodialysis units in remote areas are more expensive on a per-patient basis than hospital hemodialysis and satellite hemodialysis available in urban areas" (Ferguson et al., 2015). Based on this reality, new strategies should be put in place to save Canadians' lives in remote areas.
Policy Recommendation
The best policy recommendation revolves around establishing remote and mobile dialysis centers in the rural parts of Canada. Case studies elsewhere have proven the feasibility and possibility of these policy recommendations. Baxter Renal Therapy Services Colombia, in 2005, established a pilot program to develop dialysis centers in Colombia to overcome the barriers created by the geographic and financial issues (Thompson, 2020). The study's outcome showed that remote dialysis centers are an appropriate treatment option for individuals living in remote areas. The removal services enable healthcare workers to provide patients with care at the comfort of their homes. In supporting this strategy, the author says, "It can mitigate a patient's financial and health care inequities and provide the additional benefit of reducing travel time" (Thompson, 2020). The same strategy can help save the lives of CKD patients living in the rural parts of Canada. The success witnessed in Colombia should be replicated in rural Canada.
The remote services will allow for the mass dialysis of individuals with CKD. A point of screening can also accompany the mobile dialysis to enable people to have necessary tests as requested by the clinicians. However, this program's success will depend on several levels of collaboration (Yu & Yang, 2019). Rural communities will collaborate with local leaders, government, and the nephrology specialist teams to ensure that the process becomes successful (Lavallee, Chartrand, McLeod, Rigatto, Tangri, Dart, & Komenda, 2015). Working with nurses from rural communities will help the program identify the target and the most vulnerable areas. If working with indigenous groups, the program should consider drawing healthcare workers from these communities to leverage cultural-specific care. However, such a policy will also require the government to respond by increasing the number of a nephrologist. The Satellite Hemodialysis (SHD) program primarily failed because of the low number of nephrologists (Lavallee et al., 2015). Under the leadership of the ministry of health, the government must respond by increasing the number of nephrologists. Universities will need to enroll more students to study nephrology to cater to these vital professionals' long-term shortage.
References
Ferguson, T. W., Zacharias, J., Walker, S. R., Collister, D., Rigatto, C., Tangri, N., & Komenda, P. (2015). An economic assessment model of rural and remote satellite hemodialysis units. PLoS One , 10 (8), e0135587.
Harasemiw, O., Milks, S., Oakley, L., Lavallee, B., Chartrand, C., McLeod, L. ... & Komenda, P. (2018). Remote dwelling location is a risk factor for CKD among indigenous Canadians. Kidney international reports , 3 (4), 825-832.
Lavallee, B., Chartrand, C., McLeod, L., Rigatto, C., Tangri, N., Dart, A. ... & Komenda, P. (2015). Mass screening for chronic kidney disease in rural and remote Canadian first nation’s people: methodology and demographic characteristics . Canadian journal of kidney health and disease , 2 , 46
Thompson, S. (2020). Bringing the Revolution in Kidney Care to Canada’s Remote Communities. Canadian Policy and Public Policies https://policymagazine.ca/bringing-the-revolution-in-kidney-care-to-canadas-remote-communities/
Yu, X., & Yang, X. (2019). Remote Patient Management for Emerging Geographical Areas . In Remote Patient Management in Peritoneal Dialysis (Vol. 197, pp. 143-153). Karger Publishers.
