Enhancing Care and Saving Lives of People with CKD
The ENABLE – ‘Enhancing Care and Saving Lives of people with CKD’ study, coordinated by Kidney Research UK and funded by the Health Foundation, aims to improve the management of people with chronic kidney disease (CKD). First launched in 2009, ENABLE builds on findings from the Charity’s previous work, which focused on developing better ways to identify and treat the early stages of kidney disease. We recognised the need to share our knowledge and expertise with doctors and nurses at a primary care level, in order to help improve detection rates and delay disease progression. ENABLE therefore seeks to work with GPs and nurses on a practical basis – building knowledge and expertise in the management of patients with long-term conditions, such as CKD.
Over a three year period, we are using a specific Quality Improvement (QI) method involving the implementation of a Care Bundle for CKD in primary care. Care Bundles are groups of high impact evidence-based healthcare interventions, but the difference between this activity and normal care is that they have to be applied at the same time during one GP or practice nurse consultation. Results from the earlier study which was completed in 2010 showed improved reliability in the majority of bundle components, although the blood pressure target never achieved more than 50% reliability. Additional benefits included the identification of a small number of patients at risk of progressive CKD who required referral. The Care Bundle components are shown in Figure 1.
Due to be completed in September 2012, the project is on target to engage with almost 30 GP Practices in England (North Yorkshire, Gloucestershire, Avon, Bucks, Lincolnshire and SW London) as well as Anglesey, North and Mid Wales. We have also been successful in training a network of kidney nurses in Ireland.
Self Management Programme
One of the Care Bundle interventions is a self-management programme for patients. In the earlier pilot, it was evident to the project team that if any patient self-management programme was to be successful, it was vital to ensure that the health care professionals involved in the patient’s care, had, themselves the requisite skills, knowledge and appropriate attitude to facilitate self-management. Further details of the Self-management programme can be seen in this poster which was delivered at a workshop in July 2011.
Service User Involvement
Another key part of the ENABLE project is the involvement of ‘service users (patient and carers)’ in an active partnership with researchers, rather than just as the ‘subjects’ of research. This area is increasingly gaining international recognition as being central to health care research, policy and practice. We have set up a formal ‘user’ advisory group to encourage true user involvement in the project. The group comprises individuals with kidney disease and other vascular conditions including diabetes and heart disease. The group is contributing to all parts of the study process: creating both practitioner (GP and practice nurse) and patient materials; practitioner training as well as advice and tools to assist with evaluation of success for the user. Further details can be seen in this abstract which was delivered as an oral presentationat the British Renal Society conference in June 2011and also this presentation which was delivered by Fiona Loud, Chair of the ENABLE Patient and Service User Advisory Group at the 2012 British Renal Society Conference.
An excellent overview presentation of the ENABLE project was delivered by Dr Nicola Thomas, one of the project co-ordinators, at an international renal nursing conference in Slovenia in September 2011. Interim findings were presented as a poster at the 2012 British Renal Society conference.
By end of project, the goal is to have a new CKD resource kit for use in other Practices that includes:
- a CKD Register validation tool
- a training package for health care professionals on CKD management, Quality Improvement techniques and self-management facilitation
- a CKD self-management package for patients to encourage both self-management and collaboratively working with health care professionals
- a training package that can be delivered by patients or health care professionals to patients in a group education session
All materials will be freely available once the project has completed.
The ENABLE team is confident that they can continue to promote this innovative approach across the UK, benefiting more patients and helping the Charity to achieve its goal of saving more lives.
Contact Jo Moore for further details - jo@jcm-associates.co.uk