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Kidney Health Australia

Primary Care Education

Information Package 2016 www.kidney.org.au/health-professionals

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Prevent, Detect, Support.

Kidney Health Australia Primary Care Education 2016 2

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-to-face 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.

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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 CKD2 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 Australians4.

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/m2) Smoker Aboriginal or Torres Strait Islander origin >30 years of age History of acute kidney injury

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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 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.

Primary Care Education 2016

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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

http://www.thinkgp.org.au/kha

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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

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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.

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Modules designed for Primary Care groups (GP level education)

2. Management of stage 3 CKD in General Practice

Availability: 1 or 2 hour workshop or as part of an ALM

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.

Learning outcomes 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

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.

Learning outcomes 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

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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.

Learning outcomes

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.

Learning outcomes 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

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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.

Learning outcomes 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.

Learning outcomes 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

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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.

Learning outcomes 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.

Learning outcomes 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

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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 case-based 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.

Learning outcomes

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.

Learning outcomes 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

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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.

Learning outcomes 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

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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.

Learning outcomes 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.

Learning outcomes 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

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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!

Learning outcomes 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.

Learning outcomes • 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

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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.

Learning outcomes 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.

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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 (3rd 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.

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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 [email protected]

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.

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