1. 1 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 Slide Set 3 (rev Sept2014) SELF-MANAGEMENT FACILITATION SKILLS TRAINING

2. 2 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 Slide Set 3 (rev Sept2014) Learning outcomes To feel confident in facilitating consultations where the goal is to enhance the effectiveness of self-management of early CKD To understand how to use CKD self- management tools To understand what might be required in running group education sessions (if time)

3. 3 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 Slide Set 3 (rev Sept2014) Outline Understanding behaviour change The perfect consultation Overview of self-management activities

4. 4 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 Slide Set 3 (rev Sept2014) Patient- centred consultation Discuss project with patients and provide materials Train the Practice team Overview and outcomes Improved self - management

5. Slide Set 3 (rev Sept2014) 5 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 CKD management – how much clinician time in one year?

6. Slide Set 3 (rev Sept2014) 6 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 The reality of CKD self-management 8030 3 hours /year of professional care leaves 8757 hours /year of self-care

7. 7 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 Slide Set 3 (rev Sept2014) The person with CKD retains all the: Choices Control Consequences

8. 8 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 Slide Set 3 (rev Sept2014) Current practice: how do you usually encourage people to help themselves?

9. 9 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 Slide Set 3 (rev Sept2014) Consultations and self- management Devise a four stage consultation using only 4 of the 8 cards provided

10. 10 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 Slide Set 3 (rev Sept2014) Philosophy of care Key aspects of behaviour change 2.Overcoming barriers 1.Partnerships 3.Beliefs and attitudes 4.Action

11. 11 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 Slide Set 3 (rev Sept2014) The perfect consultation (to promote self-management) What does it look like? Explore the problem or the issue (past) Clarify feelings and meaning (present) Develop a plan (future) Commit to action (future)

12. 12 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 Slide Set 3 (rev Sept2014) Simple interviewing skills Open ended questions Affirm the person Reflect what the person feels Summarise the key points Simple interviewing skills Open ended questions Affirm the person Reflect what the person feels Summarise the key points

13. 13 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 Slide Set 3 (rev Sept2014) The perfect consultation: what does it look like? Case study discussions

14. 14 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 Slide Set 3 (rev Sept2014) Traditional interactions Information and skills are taught, based on the clinician’s agenda. There is a belief that knowledge creates behaviour change. The patient believes it is the clinician’s role to improve health. Goals are set by the clinician and success is measured by compliance with them. Decisions are made by the clinician. Collaborative interactions Patient and clinician share their agendas and collaboratively decide what information and skills are taught. There is a belief that one’s confidence in the ability to change, together with knowledge, creates behaviour change. The patient believes that they have an active role to play in changing their own behaviours to improve their own health. The patient is supported by the clinician in defining their own goals. Success is measured by an ability to attain those goals. Decisions are made as a patient-clinician partnership. Patient-clinician interactions Based on Bodenheimer California Healthcare Foundation 2005:7

15. 15 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 Slide Set 3 (rev Sept2014) BP control - taking tablets as prescribed BP monitoring at home Smoking cessation Blood sugar control (if they have diabetes) Diet: avoiding processed, high-salt, high-fat & foods and low protein diets Medicines management Lifestyle modification: exercise / weight Education – Self-management activities – Additional information resources – Support groups Key priority: Promoting self-management of CKD

16. 16 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 Slide Set 3 (rev Sept2014) Improving verbal communication Avoiding language barriers - How do you tell people they have CKD? Do you have a practice policy on these issues?

17. 17 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 Slide Set 3 (rev Sept2014)

18. 18 Project supported by A Package of Innovation for Managing kidney disease in primary care Registered Office: Nene Hall, Lynch Wood Park, Peterborough PE2 6FZ. Kidney Research UK is a limited company registered in England. Registered Company No. 905963 Registered Charity No. 252892. Registered Scottish Charity No. SC039245 Slide Set 3 (rev Sept2014) Individual consultations or group education sessions Support groups Organisations providing more information Helping people to help themselves…