Nova Scotia s Provincial Approach to Self-Monitoring of Blood Glucose (SMBG)

Transcription

1 Nova Scotia s Provincial Approach to Self-Monitoring of Blood Glucose (SMBG) DCPNS Decision Tool for.providers CPHA Conference, Montreal, PQ, June 2011 Peggy Dunbar, Provincial Program Manager

2 Special Thanks and Acknowledgements: The Diabetes Care Program of Nova Scotia would like to thank: All the participants and attending observers of the DCPNS Self- Monitoring Blood Glucose Workshop held January 2010 for helping to guide this important work Our Champions for Change Dalhousie University: Divisions of Continuing Medical and Pharmacy Education Academic Detailing (funded by DoHW and managed by CME) The Drug Evaluation Unit, Capital Health DoHW/DEANS(The Drug Evaluation Alliance of Nova Scotia)

3 Acknowledgements: The Canadian Agency for Drugs and Technologies in Health (CADTH) and the COMPUS Expert Review Committee for their extensive work on this topic background documents, reports, Café Scientifique sessions, etc. International Diabetes Federation (IDF) Guideline: Self-Monitoring of Blood Glucose in Non-Insulin Treated Type 2 Diabetes, 2009 Recommendations based on a Workshop of the International Diabetes Federation Taskforce in collaboration with the SMBG International Working Group..

4 Overview What is the issue? What is the role of the Diabetes Care Program of Nova Scotia (DCPNS) and its strategic partners? What has been done in Nova Scotia? The Decision Tool for Providers DCPNS next steps

5 Key Messages People with type 1 diabetes using basal-bolus (long- and short-acting) insulin regimens Self-monitoring of blood glucose should be individualized. Adults with type 2 diabetes usinginsulin Self-monitoring of blood glucose should be individualized, up to 14 times per week is sufficient for most of these patients. CADTH. Optimal Therapy Report COMPUS. 2009;3(7). Adults with type 2 diabetes managed on oral anti-diabetes drugs Adults with type 2 diabetes controlled by diet alone *For most patients Routine self-monitoring of blood glucose is not required.*

6 SMBG is a Hot Topic CADTH (COMPUS Report) Limited/unavailable data in support of testing in some populations (non-insulin using type 2 DM) Financial/Cost Considerations (strips cost as much as meds) Variable approaches to SMBG across and within provider groups (NS qualitative Study) Realities of testing & using test results for the person with diabetes and their health care providers Beliefs and embedded practices of health care providers

7 NS Key Players and Partners Diabetes Care Program of Nova Scotia (DCPNS) Key stakeholders diabetes educators/providers Dalhousie University CME (Medical) CPE (Pharmacy) Academic Detailing Interprofessional sessions Are We Singing from the Same Song Sheet Drug Evaluation Unit, Capital Health DEANS

8 Academic Detailing/ Academic Detailing Rx Reviewed evidence for SMBG (DEU) Discussed the clinical question Who should be self-monitoring their blood glucose and how frequently? Visited Family Physicians, Diabetes Centers & Pharmacists Distributed CADTH SMBG cards/tools, and profiled DCPNS decision tool.may to November 2010

9 Nova Scotia Partnership Activities CADTH: COMPUS Report Released (06/09) Café Scientifique: Public Providers (02/10) DEANS DCPNS SMBG Working Group DCPNS SMBG Working Group/Workshop Consensus Development (01/2010) Provider: Decision Tool Development DCPNS Provincial Workshop DEs) Academic Detailing MDs &DEs Nova Scotia Policy Feb , 100 strips/yr Early Mar., recalled Not adopting now, or anytime in future Academic Detailing Rx Pharmacists) Videos Development (1 & 2) Inter-professional Workshops (Community-based) 02/2011.

10 Where are we now? Self-Monitoring of Blood Glucose (SMBG) Tools Inter-professional Sessions Focused work with Diabetes Centres

11 Features of the Decision Tool This tool can be used to guide, and focus, group discussion and individual decision on issues of greatest concern when considering SMBG. Provides indications for testing (who should test). Provides required conditions for testing (what needs to be in place for meaningful testing). And, addresses the role of self-management education. Provides examples of low and high intensity testing and reinforces the need for time limited testing.

12 1 Instructions How to Use 1 2 Indications for Testing: Patient safety Health care team action Individual knowledge, skills, willingness to act and interpret 2 3 Recommendations: Low and high intensity Time limited testing 3

13 Comments According to working group members this tool allows for a more objective look at each individual case and removes emotion and subjectivity from the equation. Continuous use of the tool will be unnecessary as the concepts are quickly embedded in thinking/practice

14 VIDEOS Part 1: SMBG Decision Tool for Health Care Providers Provides: rationale for the decision tool with the help of key opinion leaders Part 2 : Use of the SMBG Decision Tool and Case Studies It introduces: the features of the tool, works through a sample case, provides summary caveats and principles to guide future application of the tool, and leaves three cases for the viewers to work through on their own. To locate the videos: DCPNS website

15 Introduction to the Decision Tool for Providers

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17 In closing,.. Thank you for your interest!