The primary recommendation of this Study is that renal services for people in the cross-border CA region should be provided by a regional hub service, associated satellite services and with strong linkages to community based primary health services. This preferred model represents an ideal model, with aspiration to comprehensively address the current gaps in service for Aboriginal and Torres Strait Islander renal patients. A range of practical considerations may constrain or reshape the ultimate implementation of the service model against this gold standard.
The fundamental premise of the preferred model is that it represents a structured and sustainable transition from the current urban facility model, to expansion of community based care.
Broadly, a 'hub and spoke' model, which has three broad arms, is recommended:
- The Hub renal unit would coordinate the provision of comprehensive renal services across the continuum of CKD. Alice Springs is recommended to be the Hub, given its serviced capacity, with Tennant Creek functioning as a mini hub.
- The spokes will be the sites where nurse-supported and self-care options are expanded in communities, to allow patients to be closer to home. Expansion of self-care HD and nurse-supported, mini-satellite HD are the most appropriate and sustainable options for increasing the proportion of renal patients able to return home for ongoing RRT. Several sites, based on consultation for the Study, were identified as suitable for the first wave of community care expansion.
- The spokes will not allow patients from all communities to obtain treatment closer to home: Mobile dialysis and respite dialysis is recommended to provide supplementary service to allow more people to be closer to home.