Patient Education, Diabetes Education, Structured Patient Education What does it all really mean to a person with Diabetes?

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1 Patient Education, Diabetes Education, Structured Patient Education What does it all really mean to a person with Diabetes? Linda Burns Community Diabetes Nurse Specialist Glasgow North West Diabetes MCN Staff Education Course 22 nd June 2017

2 Cost of diabetes treatment in the UK in 2012 Area of expenditure Type 1 diabetes Type 2 diabetes Total cost Percentage of costs Diabetes drugs billion billion billion 7.8% Non-diabetes drugs billion billion billion 15.2% Inpatient billion billion billion 65.8% Outpatient (excluding drugs) billion billion 1,328 billion 9.7% Other (including social service) billion 1.7% Total billion billion billion 100% Source: Kanavos, van den Aardweg and Schurer: Diabetes expenditure, burden of disease and management in 5 EU countries, LSE (Jan 2012)

3 The cost of diabetes to the NHS is over 1.5m an hour or 10% of the NHS budget for the UK. This equates to over 25,000 being spent on diabetes every minute. This equates to every second. In total, an estimated 14 billion pounds is now spent a year on treating diabetes and its complications, with the cost of treating complications representing the much higher cost. The prevalence of diabetes is estimated to rise to over 4 million by 2025.

4 Process of learning brings together cognitive, emotional, and environmental influences for acquiring knowledge, skills, and values¹ Adults learn most effectively when the teaching environment allows individuals to internalise and express their understanding of the content and its interpretations. It is not enough to just provide content - learners must be allowed to experience it through a lens that accounts for their personal experience and environment. Illeris, K. Adult education as experienced by the learners, International Journal of Lifelong Education. 2003; Vol. 22

5 Patient Education Education for people with diabetes is provided for both types of diabetes as well as at different levels of delivery to suit individual needs. Basically you need to understand:- Type 1 diabetes is when there is a severe lack of insulin in the body. Most, or all, of the cells in the pancreas that produce insulin have been destroyed. Most people diagnosed with type 1 diabetes are usually children or young people, under the age of 40 years and will need to inject insulin from the time of diagnosis. Type 2 diabetes develops due to two reasons. 1) the body still produces some insulin, although not enough for its needs, or 2) the insulin that the body produces does not work properly. Type 2 diabetes should occur in people over the age of 40 (but is now in children too) & diagnosis is closely linked to obesity, getting older & taking less activity. There are 3 levels of education we recognise as important:- Education is an ongoing process and may be referred to as following a spiral curriculum. Level 1 refers to education that is given at diagnosis of diabetes. Level 2 refers to education that is ongoing, throughout your life and normally relates to specific aspects. Level 3 refers to education that is delivered to a group of people.

6 A clear underlying philosophy on which the programme is based A structured written curriculum Trained educators familiar with the programme and its delivery A quality assurance system applied to the structure, process, content, and delivery of the programme A process of audit of programme outcomes including biomedical, psychosocial, and patient experience

7 Ongoing Diabetes Education Work in GGC Diabetes MCN developed patient pathways for Type 1 and Type 2 education with a move towards quality assurance for all courses now being provided. Multi-disciplinary working groups are reviewing current provision and developing action plans to improve provision of Type 1 & Type 2 patient education. New Continuing education programme has been developed Mastering Type 2 Diabetes Mellitus for ongoing update.

8 Type 1 Diabetes Patient Education

9 Type 1 Diabetes structured education courses are usually offered at Diabetes centres throughout Scotland DAFNE - Dose Adjustment For Normal Eating Course (from 2000) A national course with trained educators over 5 days usually by attending in a group format & running in Glasgow & Clyde currently. Gives people with Type 1 Diabetes a toolkit which is evidence based to manage their insulin and lifestyle more effectively with. Vital Statistics 5,795 DAFNE courses have been delivered in 75 centres in UK & Eire Resulting in 39,649 DAFNE Graduates. Number of DAFNE courses planned for October 2016: 58 Last Updated: 30/09/2016 & course exported to Australia, New Zealand, Taiwan, Saudi Arabia, Spain, Nigeria & South Africa A range of Locally developed courses at other Diabetes centres aiming to meet national diabetes APED quality standards in Scotland.

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12 Type 2 Diabetes Patient Education

13 Conversation Maps Its Good to talk

14 Diabetes Conversation Maps A comprehensive and unique set of educational tools known as Conversation Maps Designed to engage patients in the learning process and help them become better self managers through group sessions Developed in accordance with Clinical Practice Guidelines

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16 Diabetes self-management education and ongoing self-management support are crucial components of effective diabetes care and significant contributors to the metabolic and psychological outcomes of people with type 2 diabetes. - So why don t we really value it in the NHS?

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18 Conversation Map (CM) education tools are a series of tools for facilitated group education that were developed by Healthy Interactions in collaboration with the International Diabetes Federation (IDF) and are sponsored by Lilly Diabetes in the UK. Different CM versions have been developed for specific regions or countries (United States, Canada, Europe, Asia, Australia, Latin America, and Africa) in co-operation with national and international diabetes associations (IDF and the Canadian, American, and Diabetes (UK) patient associations) to reflect differences in culture and background. CM-based education learning tools guide people with diabetes through a process with the aim of helping them understand and internalise information about their disease and generate insightful conclusions, which may then result in improved self-management decisions and actions

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20 How do Conversation Maps work? Participating in the group helps to promote understanding of type 2 diabetes, allowing people with diabetes to be more questioning & knowledgeable about what will positively benefit their long-term health as they live with the condition. The course aims to dispel any myths about the condition, and any illness beliefs that are false or potentially damaging. It should help patients to see their illness in a biomedical model, as well as the personal, functional and social model that most of us use as the initial conceptual framework for understanding the impact of the illness. It should enable patients to start to monitor their type 2 diabetes more effectively, realise when their control is inadequate, and enable them to self-manage their lifestyle, nutrition and medication to bring about improvement in diabetic control, or know when to seek professional help. It should enable them to be an active partner in the management of their type 2 diabetes, along with healthcare professionals.

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22 Patients share if they wish through peer conversation their... Thoughts and feelings around diabetes. Discussion helps understanding about their diabetes & glucose: what happens in the body. Insight and understanding about the risk factors and complications associated with diabetes. Understanding about monitoring and medication. Encouragement for other patients on how to take control by discussing - Food Choices Physical Activity. Planning for the future. Setting goals. Knowing their diabetes numbers & targets

23 Training Educators After completing the Conversation Map training, facilitators are able to incorporate new education techniques into their practice, which can help drive greater information retention and help positively affect behaviour. The training can expand the skill set of healthcare professionals by enhancing group-session facilitation skills. A new role for educators that of a facilitator rather than just a dispenser of facts. Educators are there to ensure that information shared within the group is correct. Training workshops 4 hours arranged through Lilly representative

24 Do you know how to refer patients locally to diabetes structured education classes? For patients with newly diagnosed Type 2 Diabetes : by (paper) referral from GP Practice to local CHSP Diabetes Education co-ordinator for offer of Conversation Map classes at a local health centre.

25 Although knowledge alone is likely to be insufficient to achieve changes in HbA1c on its own, it is evident from prior research that behaviour & ultimately clinical outcomes are unlikely to change unless there is knowledge together with an understanding of the need to change, what to change, and how to change it. Knowledge is necessary for; diabetes self-management behaviour, physical and psychological well-being, glycaemic control (HbA1c), body weight and attainment of personal therapeutic goals

26 Friends, family, internet, patient organisations, internet, media, newspapers, patient support groups, charities, social media, smartphone apps, books, leaflets, other people with diabetes &... &...

27 National resources are available to support people with diabetes: Children and Young People with Type 1 Diabetes in Education a guide to what policies should contain. Self management is essential for people with diabetes. The Health and Social Care Alliance provides tools for people in self management. People with diabetes can log into their own diabetes information through My Diabetes My Way NHS Inform is Scotland s national health information service that provides information on diabetes. Nutrition and Diet Resources (NDR-UK) provide dietary information on the management and treatment of diabetes for all age groups and the South Asian population. NHS Scotland s interactive diabetes website helps support people who have diabetes, their family & friends. There are leaflets, videos, educational tools and games containing information about diabetes. If you have diabetes, you can also register and view your own up-to-date diabetes clinic results. The Juvenile Diabetes Research Foundation many resources for children & young people living with diabetes. Diabetes UK is the leading diabetes charity. The website hosts many resources for people with diabetes and professionals working in diabetes. The Diabetes in Healthcare Training Course website is for both healthcare professionals who wish to know more about diabetes but who are not diabetes specialists and people with type 2 diabetes. For nurses, it has been credited by the Royal College of Nursing. ALISS (A Local Information System for Scotland) a search & collaboration tool for Health and Wellbeing resources in Scotland. It helps signpost people to useful community support, with an ALISS account you can contribute to the many and varied resources that our local communities have to offer. Culturally specific resources The Knowledge Network hosts language specific resources provided by the voluntary sector to support staff educating people about their diabetes

28 Scottish Diabetes Research Network People who wish to participate in research in diabetes can register their interest to be involved. Once you are registered on the diabetes register, individual researchers will approach you directly to ask for your consent for specific studies. You can withdraw your consent at any time. Patient to patient Peer support is essential for self-management. This section will signpost you to e-resources developed by people with diabetes for people with diabetes. Our Diabetes, diabetes.co.uk are community led, community focused platforms that enables people with diabetes to be empowered, educated and supported in their condition. Generic Courses The Women with Diabetes website has been developed for professionals working with women with diabetes. The Change4life provides suggestions about making positive changes to childrens' diets to promote healthier eating. Type 2 Diabetes and Me This course will help you understand and start managing your condition. From diet to treatments and where to get support, you ll find all the information you need.

29 Thank you Any questions?