Policy into practice: renal examples
In New Zealand several areas in nephrology have recently
reached the national health policy agenda. Because of the
current diabetes epidemic in New Zealand, better prevention
and management of diabetes is now a primary focus of the
agenda. Given that diabetes is the principal driver of the growth
in ESKD, improved management of CKD in primary care has
become an associated focus with diabetes. Over the last three
years the Ministry has, via a Request for Funding contracting
process, funded four pilot projects testing innovative models of
care for people with diabetes who either already have, or are at
high risk of, kidney disease. Expert nurses from renal services,
extending their roles by working with nurses in primary care
practice settings, have been integral to three of the four pilots,
from contributing to the planning and design through working
with primary care clinicians to establish the services to actually
leading the clinics and reporting the results (Walker et al, 2013).
The success of these pilots has been dependent on the skills of
these specialist renal nurses, ranging from mentoring practice
nurses and liaising with general practitioners to advising on
service redesign and quality assurance programmes in primary
care.
Renal transplantation is now on the national health policy
agenda. A proposal from the NRAB, combined with media
publicity about the low rates of renal transplantation, led to
Ministerial initiative in 2012 to increase renal transplantation
in New Zealand, with a new funding stream to support several
new initiatives. Recognition of the difficulty people needing a
renal transplant can have in relating to their family and friends
who are potential donors was demonstrated in recent research
in New Zealand (Martin, 2013).This has resulted in a major
pilot project to increase live kidney donation.The outcome of
a Request for Proposal contracting process, the project is sited
in an area with very low rates of live donation. Live Kidney