Kidney Health Australia Primary Care Education Information Package 2016 www.kidney.org.au/health-professionals
Who is Kidney Health Australia? Kidney Health Australia (KHA) is a not-for-profit organisation whose focus is to improve kidney health outcomes and quality of life for people with kidney and urinary tract diseases, their families and carers. Our organisation has a rich history that has seen our focus broaden from the funding of cutting-edge medical research to incorporating the delivery of needs and evidence-based health programs and services, including our Primary Care Education Program. Our Mission To promote good kidney health through education, advocacy, research and support Our Vision To save and improve the lives of Australians affected by kidney disease Primary Care Education KHA has been providing education to primary care health professionals since 2001. The initial aim was to improve the health outcomes for people with chronic kidney disease (CKD) by ensuring that general practitioners (GP) were aware of the guidelines around early detection and management of chronic kidney disease (CKD). The scope of this education has now broadened and encompasses: all primary care health professionals, especially primary care nurses health professionals working in indigenous communities community pharmacists who are involved with preventative health activities education on other chronic diseases that commonly co-exist with kidney disease, such as diabetes and cardiovascular disease Primary care education activities are governed by an expert committee, called the Primary Care Education Advisory Committee for KHA (PEAK). This committee is comprised of prominent kidney specialists, general practitioners, primary health nurses, educators and government representatives. The committee is chaired by Professor David Johnson (MB BS (Hons, Univ Medal), FRACP, DMed(Res), FASN, PhD (Syd)). To date, KHA has: Provided education to over 28,000 health professionals through either our face-toface or online learning modules Printed over 55,000 copies of the CKD Management in General Practice handbook Developed the CKD-Go phone app; providing easy access to individualised care plans. KHA continues to be the leading voice in kidney education in Australia. We are the only organisation offering a comprehensive education program on kidney disease, diabetes and cardiovascular disease to health professionals in primary care. Kidney Health Australia Primary Care Education 2016 2
Why is chronic disease education important? Chronic kidney disease (CKD) presents a significant health problem in Australia. It is an important contributor to morbidity and mortality in the Australian population. 1 in 3 Australian adults is at increased risk of developing CKD due to identified risk factors including age, high blood pressure and diabetes. 1 1 in 10 Australians aged over 18 have indicators of CKD 2 Individuals with CKD are 2-3 fold greater risk of cardiac death than individuals without CKD. 3 CKD, cardiovascular disease and diabetes have a substantial impact on the health of Australians, affecting almost 1 in 4 adult Australians, or an estimated 3.7 million Australians 4. A person can lose up to 90% of their kidney function before experiencing any symptoms. The usual setting for initial assessment and diagnosis of CKD is in general practice. 3 CKD is not being adequately detected or appropriately managed in primary care. 2,5 KHA believe that through educating our health professionals on the detection and management of CKD, we have the opportunity to empower primary health care professionals, improve health outcomes for individuals living with CKD, and reduce the burden of CKD in the community. We also have the opportunity to impact on other chronic disease outcomes. CKD, cardiovascular disease and diabetes share many risk factors, such as high blood pressure, obesity, and smoking. There are also complex causal relationships between these conditions, and each of them may be caused by, or be a complication of, one or both of the other conditions. Modifying and controlling shared risk factors for these diseases not only reduces the risk of onset of disease, but also has a favourable impact on disease progression and the development of complications - with the potential for large health gains in the population. Recent content focus of the primary care education program includes a strong focus on the links between diabetes, cardiovascular health and kidney health. Who is at risk of CKD? People with one or more of the following risk factors are considered to be at a higher risk of developing kidney disease than the general population. Diabetes Hypertension Established cardiovascular disease Family history of kidney failure Obesity (BMI >30kg/m 2 ) Smoker Aboriginal or Torres Strait Islander origin >30 years of age History of acute kidney injury Kidney Health Australia Primary Care Education 2016 3
We believe that through educating our health professionals on the detection and management of kidney disease, we have the opportunity to empower our primary health care professionals, improve health outcomes for individuals living with kidney disease, and reduce the burden of CKD in the community. Primary Care Education 2016 Primary Care Initiatives KHA is actively involved in advancing the national CKD agenda, and leads the way in setting messaging and recommendations for kidney disease detection and management in Australia. The major initiative of our Primary Care Education Program has been the development and implementation of a series of world-class workshop modules for Australian primary care health professionals. These modules are run as interactive face-to-face or online learning sessions aiming to improve the knowledge, detection and management of CKD in general practice. Each year new modules are added and all modules are modified to meet the changing demands of the health system. In 2015 the CKD-Go phone app was launched to support GPs and KHA with the expert committee have identified that other initiatives such as decision support software will enhance GP practice in appropriate screening and management. Additional KHA primary care activities include the development and publication of position statements, peer-reviewed articles, government advocacy, conference presentations, and guideline booklets on CKD detection and management. We also partner with a variety of organisations (such as Aboriginal Health Councils, nurse practitioner led clinics and general practitioner training organisations) to establish new avenues for educating health professionals on kidney disease detection and management. KHA has also launched the inaugural Primary Care Practice Awards that aim to recognise excellence in chronic kidney disease care for primary care practice. Primary Care Education workshops In 2016 KHA will continue to provide education on CKD to GPs, primary health nurses, pharmacists and other primary health care professionals through our Primary Care Education program. There is a particular focus on expansion of programs to include diabetes and cardiovascular disease, and to meet the needs of the Indigenous community. KHA works closely with General Practice member organisations such as Primary Health Networks, GP Training organisations and other groups interested in running education sessions on kidney and related diseases for health professionals in their areas. Education modules are provided as a complete educational package including a program, session plan, presentation, case studies, handouts, evaluation forms and reporting. Kidney Health Australia Primary Care Education 2016 4
Primary care education is designed to be interactive with group activities, case studies and discussion underpinning the presentation format. Education sessions are facilitated by a Nephrologist or Renal Nurse who is carefully selected to fit with the audience and learning objectives for the session. Primary care education is offered in the following formats: Interactive face-to-face workshops (usually 1 hour or 2 hour sessions) Active Learning Modules run as full day workshops or split over multiple dates Online learning Conference sessions Interactive web-based sessions All primary care education modules are accredited for Continuing Professional Development with the Royal Australian College of General Practitioners (RACGP), and the Australian College of Rural and Remote Medicine (ACRRM) as well as with the Australian Primary Health Care Nurses Association (APNA). Online Learning for Primary Care In addition to our interactive face to face workshops, KHA currently offers three online learning modules for health professionals. These modules run for one or two hours and are offered through our online learning provider ThinkGP. Online learning modules 1 Chronic Kidney Disease (CKD) management in General Practice (1 hour) 2 Diabetes and Chronic Kidney Disease: a sinister combination (1 hour) 3 Chronic Kidney Disease Issues for General Practitioners (2 hours) Each of these modules can be accessed 24 hours per day and is accredited for RACGP and ACRRM points. Visit www.thinkgp.org.au/kha Kidney Health Australia Primary Care Education 2016 5
Primary Care Education Booking Process To host a workshop you Contact the Primary Care Education team Select the module(s) you would like to have presented. A description of each module is provided Nominate your preferred dates some flexibility may be required to fit in with speaker availability, particularly in rural areas Arrange the venue, catering and sponsor (if applicable) Invite participants (KHA provides a template flyer for your use) On completion of a workshop, return attendance list, evaluation forms and summary and a completed host feedback form to KHA Issue individual certificates (template is provided) to workshop participants KHA will Source an appropriate speaker for your workshop (usually a Nephrologist or Renal Nurse) where possible we will try to use a local presenter and confirm workshop booking details at the earliest convenience Cover the costs incurred by the speaker (if previously arranged) E-mail you all workshop materials (template invitations, certificates, evaluations, case study notes etc.) and post out copies of the publication Chronic Kidney Disease in General Practice for each participant Complete administration requirements associated with RACGP & ACCRM accreditation if applicable & arranged in advance Prepare an activity report which is provided to the hosting organisation, speaker and accreditation bodies Contact the KHA Primary Care Education team An expert a speaker is sourced for your session and workshop details are confirmed by KHA All workshop materials and CPD accreditation are provided by KHA (where applicable) Workshop is held. You return evaluations, attendance and feedback to KHA Post workshop admin requirements are completed by KHA Kidney Health Australia Primary Care Education 2016 6
The Primary Care Education Modules Workshops for Primary Care audiences (information at a GP level) 1 Early detection and management of CKD 2 Management of stage 3 CKD in General Practice 3 Management of stage 4 & 5 CKD 4 Decision making and symptom control in ESKD 5 CKD: issues for General Practitioners 6 CKD and Diabetes: A sinister combination 7 Management of resistant hypertension in General Practice 8 Cardiovascular risk reduction in CKD 9 egfr and drug dosing (suitable for pharmacists) 10 CKD in Indigenous Australians 11 Acute Kidney Injury & Chronic Kidney Disease: Is this the same disease? Workshops for Primary Care Nurses 1 Detecting and managing CKD for the primary care nurse 2 CKD & Diabetes: make the connection, change the management 3 Nurse leadership in cardiovascular risk reduction in CKD 4 Older People and Chronic Kidney Disease Workshops for Aboriginal and Torres Strait Islander Health Workers / Practitioners 1 Understanding CKD: Aboriginal and Torres Strait Islander Health Workers and Health Practitioners Each module is accredited for continuing education points with the RACGP, and ACRRM* You do not need to apply for points for these workshops just let us know prior to running the workshop that you would like the event accredited for CPD points. *All 2 hour modules are already accredited as repeated activities allocated 4 (Cat 2) points in the RACGP QI&CPD program for the 2014-2016 triennium. Kidney Health Australia is an authorised provider of accredited activities under the RACGP QI&CPD Program. Each module has been approved with ACRRM for 2 Core PDP points. Kidney Health Australia Primary Care Education 2016 7
Modules designed for Primary Care groups (GP level education) 1. Early detection & management of Chronic Kidney Disease This module highlights the importance of the early detection of CKD and explores the recommendations for detection and monitoring CKD in general practice. The workshop covers the measurement and reporting of urinary albumin and protein, developments regarding the use of egfr, and the new staging of CKD. The module is designed to be interactive and explores the use of egfr and kidney function tests to detect CKD and the use of a CKD action plan to manage the condition according to the stage of CKD. It also highlights how the revised CKD Management Booklet and Early Chronic Kidney Disease guidelines are important tools for general practice. Know the major risk factors for developing CKD Implement the recommendations for the detection and staging of CKD Know why the early detection and management of CKD is important Be able to implement treatment options to delay progression of kidney disease Understand the importance of developing a system to identify patients at higher risk of CKD for a Kidney Health Check 2. Management of stage 3 CKD in General Practice This presentation focuses on the management of stage 3 CKD in general practice. Areas covered include proteinuria, pharmaceutical control of kidney disease blood pressure targets, calcium / phosphate disturbance, anaemia and referral to a Nephrologist. The case of Bruce is followed in this interactive workshop which includes a didactic presentation, group work and plenary discussion. Demonstrate the ability to stage chronic kidney disease (CKD) through accurate interpretation of kidney function Define the goals for best practice management of CKD, particularly stage 3 Display increased confidence in the ability to manage stage 3 kidney disease Have improved knowledge of when to refer patients with CKD to a Nephrologist Be able to implement a practice based system to identify patients at higher risk of CKD for a kidney health check Kidney Health Australia Primary Care Education 2016 8
3. Management of stage 4/5 CKD The management of CKD is always a collaborative effort. As kidney function declines, complications and comorbidities increase. Even if the individual progresses to stage 4 or 5 CKD and has regular contact with the dialysis or transplant team, the primary care team remain vital to optimal care. This workshop uses a didactic presentation and interactive case study to highlight the issues associated with management of people with advanced CKD. After attending the workshop, participants will have increased knowledge and confidence in managing their patients with stage 4 or 5 CKD. Display increased knowledge of the incidence and prevalence of CKD Display improved knowledge of management goals of advanced CKD Have increased confidence in detecting and managing complications of advanced CKD Have improved knowledge of when to refer patients to a nephrologist Understand the impact of advanced CKD on drug dosage reduction and cessation Be able to implement a practice-based system to perform a Kidney Health Check for patients at increased risk of CKD 4. Decision making and symptom control in End Stage Kidney Disease Conservative care is the treatment choice for kidney failure when an individual has decided that the options of dialysis and transplant are not appropriate for them. For many people who are already frail their life-span with kidney failure, with or without dialysis, is very similar. This workshop covers renal care and palliative care concerns in general practice. It focuses on an individual s symptoms and the treatment of their complications when not starting dialysis and management is in primary care, and provides tools to help patients make informed decisions and choices regarding their care. Describe supportive care as a treatment option for end stage kidney disease (ESKD) Recognise and manage common symptoms and complications in ESKD. Outline the components of terminal phase care for the patient with ESKD Integrate the resources available for decision-making support in patients with ESKD in the practice setting Kidney Health Australia Primary Care Education 2016 9
5. CKD: issues for General Practitioners This module looks at some of the more difficult areas in CKD that general practitioners may encounter. The issues of risk in CKD, diabetic kidney disease, heavy proteinuria and difficult hypertension are explored through 4 different case studies. Understand the role of the GP in preventing and detecting CKD Increase knowledge and confidence in managing diabetic kidney disease Increase knowledge of the nephrotic syndrome and its management Increase knowledge and confidence in managing difficult hypertension Be able to implement a system to perform a kidney health check for patients at increased risk of CKD 6. A sinister combination: CKD & diabetes This workshop investigates the relationship between kidney disease and diabetes and the significant changes in management that are required in individuals who have both conditions. Diabetes is the leading cause of kidney disease and approximately 1/3 of all people with diabetes will have Diabetic Kidney Disease (DKD). This interactive workshop explores the management of diabetes in the context of kidney disease and provides GPs with straightforward solutions to the management of DKD in general practice. State the major risk factors for developing chronic kidney disease (CKD) Determine the stage of chronic kidney disease (CKD) through accurate interpretation of kidney function Define the goals for best practice management of CKD, particularly Diabetic Kidney Disease Recognise the importance of screening high risk individuals for CKD Implement a practice-based system to perform a kidney health check in patients with Diabetes and those at increased risk of CKD Kidney Health Australia Primary Care Education 2016 10
7. Management of resistant hypertension in General Practice This presentation explores the common interaction between kidney function and cardiovascular disease. One in five Australian adults suffers from hypertension, and kidney disease is a significant problem for these patients. This interactive workshop investigates how timely intervention and appropriate management of resistant hypertension can slow or prevent the progression of CKD. Outline the causes and associations of resistant hypertension Recognise the difference from pseudo-resistant hypertension, and diagnose accordingly Recognise the significance of the relationship between resistant hypertension and CKD Define best management for resistant hypertension including lifestyle and pharmacological management Create individualised management plans for patients in order to maximise achievement of targets whilst minimising harm 8. Cardiovascular risk reduction in CKD CKD is an independent and highly significant risk factor for cardiovascular disease. Individuals with CKD have a 2-3 fold greater risk of cardiac death than individuals without CKD. This module focuses on the relationship between kidney function and absolute cardiovascular risk, and the importance of addressing cardiovascular risk in patients with CKD. It also explores the special aspects of CVD risk reduction in people with CKD in general practice, and highlights the differences a CKD diagnosis will make to the management strategies, treatment targets and therapy choices for your patients. Describe the relationship between kidney function and Absolute Cardiovascular Risk, and the importance of addressing cardiovascular risk in patients with CKD Define the goals for management of CKD and Absolute Cardiovascular Risk and feel confident incorporating these into your practice Explain the difference a CKD diagnosis will make to the management strategies, treatment targets and therapy choices for your patients Improve patient safety by implementing practice systems to routinely assess and manage cardiovascular risk in patients with or at risk of CKD Kidney Health Australia Primary Care Education 2016 11
9. egfr and drug dosing (suitable for pharmacists) Ten percent of people attending general practice have CKD, and most have related conditions such as high blood pressure and diabetes. Renal drug clearance is an important factor to consider when selecting a drug dose for a patient with CKD. Factors that should be taken into consideration include the method of determining kidney function, body size, and therapeutic index. This workshop addresses these issues using an interactive casebased format. Participants will be able to understand the accuracy of the new CKD-EPI egfr formula compared to other estimates of GFR, and will increase their confidence in making drug dosing decisions for their patients with CKD. State the recommendations for the detection and staging of Chronic Kidney Disease Explain the importance of developing a system to identify patients at higher risk of CKD for a Kidney Health Check Differentiate the accuracy of the CKD-EPI egfr formula compared to other estimate of GFR Identify the relative importance of GFR estimations in CKD drug dosing 10. CKD in Aboriginal or Torres Strait Islanders This presentation focuses on the management of CKD in general practice and highlights the prevalence and management strategies specific to Indigenous Australians. The presentation includes information on proteinuria, blood pressure targets, calcium / phosphate disturbance, anaemia and when to refer to a Nephrologist. The case of Doreen, an Indigenous woman with CKD is central to the workshop which combines a didactic presentation, with group work and plenary discussion. After attending the workshop, participants should be able to set up a system in their practice to identify Indigenous and other high risk individuals for a Kidney Health Check. Be aware of the high prevalence and poor outcomes of CKD in Australian Indigenous people Understand the importance of early detection and management of CKD Be able to stage CKD and assess for complications Know the treatment options to delay progression and prevent complications Be able to implement a practice-based system for screening for CKD in Indigenous and other high risk patients Kidney Health Australia Primary Care Education 2016 12
NEW IN 2016 11. Acute Kidney Injury & Chronic Kidney Disease: is this the same disease? This workshop explores the relationship between Acute Kidney Injury and CKD. CKD increases the risk of AKI, and an episode of AKI in turn increases the likelihood of subsequent development of CKD, highlighting the need for ongoing surveillance. General practice is in a unique position to identify people at increased of AKI and address potentially modifiable exposures to prevent the occurrence of AKI. Be able to define Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) Have an understanding of and be able to describe the relationship between AKI and CKD Effectively utilise practice systems to implement screening for patients at risk of both CKD and AKI Establish appropriate monitoring and treatment objectives for patients Be able to discuss and implement appropriate management of acute and chronic kidney disease Kidney Health Australia Primary Care Education 2016 13
Modules designed for Primary Care Nurses 1. Detecting & managing CKD for the primary care nurse This module highlights the importance of the early detection of CKD and explores the recommendations for detection and monitoring CKD in general practice. The module has been specifically designed for Primary Care nurses and aims to highlight the important role nurses have in the early detection & management of CKD. The module is designed to be interactive and explores the use of egfr and kidney function tests to detect CKD and the use of a CKD action plan to manage the condition according to the stage of CKD. It highlights the use of relevant MBS item numbers and discussed how nurses can build CKD care into their Chronic Disease Management. Know the major risk factors for developing Chronic Kidney Disease (CKD) Understand the recommendations for the detection and staging of CKD Be able to identify the role of the primary care nurse in the detection and management of CKD Develop confidence to include CKD testing and management as part of chronic disease management 2. CKD & diabetes: make the connection, change the management Diabetes is one of the major risk factors for CKD with recent evidence suggesting diabetes is the underlying cause of CKD in over 30% of cases. This presentation will investigate the relationship between CKD and diabetes and the role of the practice nurse in managing diabetes in the context of chronic kidney disease. State the major risk factors for developing chronic kidney disease (CKD) Determine the stage of chronic kidney disease (CKD) through accurate interpretation of kidney function test results Outline the adverse outcomes of a combined Diabetes and CKD diagnosis (DKD) Explore the nurse's role in early detection, reducing the modifiable risk factors and management of DKD Develop a system to screen at risk patients that includes CKD testing and management Kidney Health Australia Primary Care Education 2016 14
3. Nurse leadership in cardiovascular risk reduction in CKD This session is essential for any primary care nurse who sees patients with chronic kidney disease, and cardiovascular disease. Chronic Kidney Disease (CKD) is so commonly seen in General Practice, yet we are often asked what do I do next? The session is designed to be interactive and follows the case study of Tony a typical CKD patient. Participants are encouraged to discuss their ideas and ask lots of questions! Over the course of the session we cover areas such as the risk factors and recommended tests for CKD, the CKD staging system and management plans as well as and the relationship of CKD with cardiovascular disease. By the end of the session, nurses should have a firm grasp of the key elements in best practice CKD management and should be armed and ready to tackle this condition head on! Understand the burden of Chronic Kidney Disease (CKD) in Australia and how to screen for it with a Kidney Health Check Understand the importance of addressing cardiovascular risk in patients with chronic kidney disease (CKD) Know the goals for management of CKD and Absolute Cardiovascular Risk and integrate the knowledge learned into your practice Have increased knowledge of the difference a CKD diagnosis will make to the management strategies, treatment targets and therapy choices for patients Improve patient safety outcomes by implementing nurse led systems to routinely assess and manage cardiovascular risk in patients with or at risk of CKD NEW IN 2016 4. Older People and Chronic Kidney Disease CKD is very common in older people with up to 42% of people aged over 75 having some degree of CKD. It often occurs in the presence of multiple medical conditions and comorbidities. This workshop looks at the relationship of kidney function to ageing and covers the special issues associated with the management of CKD in older people. State the major risk factors for developing chronic kidney disease (CKD) State the relationship of kidney function to ageing Be able to identify the role of the primary care nurse in the detection and management of CKD in older people Develop confidence to include CKD testing and management as part of chronic disease management of older people Kidney Health Australia Primary Care Education 2016 15
NEW! Modules designed for Aboriginal and Torres Strait Islander Health Workers & Practitioners NEW IN 2016 1. Understanding Chronic Kidney Disease - Aboriginal and Torres Strait Islander Health Workers and Practitioners CKD is much more common in the Aboriginal and Torres Strait Islander population and often goes undiagnosed. This workshop focusses on the role of the Aboriginal / Torres Strait Islander Health Worker in the detection and management on CKD. It highlights how to detect CKD and what management should occur in Primary Care along with providing an understanding of the various decisions that have to be made in the ongoing management of CKD. After completing this education, health workers should feel confident discussing CKD and including it as part of their general chronic disease management. Be aware of the high prevalence and poor outcomes of chronic kidney disease (CKD) in Australian Aboriginal and Torres Strait Islander people. Know the major risk factors for developing CKD Be able to identify the role of the Primary Care Health Worker/ Practitioner in the detection and management of CKD and gain an understanding of decisions the health care team and patients have to make to help in CKD Learn some language (jargon) of CKD and develop confidence to discuss CKD testing and management as part of chronic disease management. Kidney Health Australia Primary Care Education 2016 16
Reference List 1. Chadban SJ, Briganti EM, Kerr PG et al. Prevalence of kidney damage in Australian adults: The AusDiab kidney study. J Am Soc Nephrol 2003; 14: S131-S138 2. Australian Bureau of Statistics. Australian Health Survey: Biomedical Results for Chronic Diseases, 2011-12. 2013. ABS, Canberra. 3. Kidney Health Australia. Chronic kidney disease (CKD) management in general practice (3 rd Edition). 2015. Kidney Health Australia, Melb, VIC. 4. Australian Institute of Health and Welfare. Cardiovascular disease, diabetes and chronic kidney disease-australian facts: risk factors. 2015. Cardiovascular, diabetes and chronic kidney disease series no. 4. Cat. no. CDK 4. Canberra: AIHW. 5. Howard K, Salkeld G, White S et al. The cost-effectiveness of early detection and intervention to prevent the progression of chronic kidney disease in Australia. 2006. Kidney Health Australia, Melbourne, Australia. Kidney Health Australia Primary Care Education 2016 17
Further information For further information on Kidney Health Australia s Primary Care Education Program, or to book a workshop, please contact our Primary Care Education team: 08 8334 7512 PrimaryCare@kidney.org.au 136 Frome Street, Adelaide GPO Box 9993, Adelaide SA 5001 www.kidney.org.au/health-professionals KHA s Primary Care Education Program is proudly associated with the following organisations Kidney Health Australia is an authorised provider of accredited activities under the RACGP QI&CPD program We would like to thank the following organisation whose support helps make the education program a reality. Version: 0816 Kidney Health Australia Primary Care Education 2016 18