Diabetes education: the big missed opportunity in diabetes care? Phaedra Perry Regional Head South West Katherine Calder Senior Policy Officer

Transcription

1 Diabetes education: the big missed opportunity in diabetes care? Phaedra Perry Regional Head South West Katherine Calder Senior Policy Officer

2 What is diabetes self-management education? A menu of education options Informal, flexible, ongoing Information & one-to-one advice Structured education (meets NICE criteria QS6)

3 Why is diabetes self-management education and support important? 3 HOURS 8,757 HOURS

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5 80% of NHS spending on diabetes goes on managing complications, most of which could be prevented. Primary care spends over 2.3 million a day on diabetes drugs; yet adherence to therapies among patients with chronic conditions averages only 50%.

6 What is the evidence base for diabetes education?

7 Locally designed courses

8 Systematic review of group-based education for people with Type 2 diabetes assessed 21 randomised controlled trials. Significant improvements in: glycaemic control (significantly reduced fasting blood glucose levels and HbA1c, the latter by 0.46 percentage points at one year) self-management skills diabetes knowledge self-efficacy/empowerment patient satisfaction body weight at 12 months.

9 X-PERT audit: increases people s diabetes self-management skills and confidence improves HbA1c (by 0.5 percentage points at one year) reduces cardiovascular risk factors. DESMOND randomised controlled trial: supports weight loss and smoking cessation improves people s understanding of diabetes reduces depression at 12 months However, evidence suggests that the programme needs to continue for improvements to be sustained.

10 DAFNE (Type 1 diabetes) has been shown to: significantly improve long-term glycaemic control reducing HbA1c by 1.0 percentage points at 6 months, 0.5 at one year and 0.3 at 7 years reduce the risk of severe hypoglycaemia by 67% and ketoacidosis by 61%, substantially reducing emergency treatment costs restore hypoglycaemia awareness improve quality of life and perceived well-being reduce anxiety and depression SOURCE: Evidence summarised in Diabetes UK (2015). Diabetes education: the big missed opportunity in diabetes care

11 Value for money? DAFNE: Savings are estimated at 48 million per year nationally or 93,133 per 100,000 population Department of Health. DESMOND & X-PERT: both considered cost effective compared with usual care, one study suggests that, if rolled out to everyone with Type 2 diabetes, X-PERT could save 367 million per year as a result of reduced medication costs. Use lay educators (partnered with HCP) to increase educator capacity and improve the cost effectiveness of Type 2 courses.

12 Improving uptake (1) 1. Review diabetes education provision to identify local priorities and barriers to uptake; consult HCPs and people with diabetes. 2. Establish a robust service specification for education providers including data collection and KPIs. 3. Set ambitious but achievable targets benchmarking against other areas can be helpful. 4. Offer a menu of education options, including structured (level 3) courses and less formal, ongoing support e.g. peer support, online learning, one-to-one support (levels 1 and 2).

13 Improving uptake (2) 5. Offer courses in a range of venues in the community and at a range of times identify what works for the local population. 6. Marketing is key: plan effective internal and external communications to HCPs and people with diabetes. 7. Use an electronic referral form and allow patients to self-refer. Consider a dedicated administrator. 8. Promote and train HCPs in collaborative care planning to empower patients and identify selfmanagement needs.

14 What can you do? Local NHS decision makers Put plans in place to make sure everyone with diabetes has the skills and confidence to manage their condition. Check out our resource about the value of diabetes education courses (PDF, 257KB) and our checklist about what to consider when looking at providing diabetes education (PDF, 247KB). Work with healthcare professionals to boost and improve referrals (PDF, 65KB). Review uptake of local programmes, identify barriers and assess the effectiveness of courses. Healthcare professionals Talk to your patients about the value of diabetes education you can order our free posters, flyers or healthcare professional resource on the online shop. If you d like to get involved in the campaign, make the case for diabetes education locally or would like to share your experience, get in touch at policy@diabetes.org.uk.

15 How can Diabetes UK help you?

16 What s the current situation? Uptake is low in many areas (although data problems): Type 1 newly diagnosed Type 2 newly diagnosed Offered (12/13) Attended (12/13) Offered (14/15) 4% 1% 33% 2% 17% 4% 79% 6% Attended (14/15) Provision varies: more than a third of CCGs don t commission some courses. Data collection is patchy: over 50% of CCGs don t know how many people are attending some or all of their courses. SOURCE: National Diabetes Audit 2012/13 and 2014/15 England national figures.

17 Diabetes education: FOI data in the South West Katherine Calder Senior Policy Officer

18 Diabetes UK FOI on structured education About the FOI data: Freedom of Information request sent to all CCGs: 100% response rate (but quality of responses varies hugely!) Provides richer picture of SDE commissioning locally what programmes, for whom, contract type, costs, attendance figures, waiting list etc. BUT the caveats: Not up to date FOI submitted in June 2015 Quality of responses varies widely some CCGs supplied much more data than others; may not be 100% accurate. Tells us about commissioning, but not necessarily provision: providers may have different (more complete?) data. Sometimes challenging to know what courses count as SDE we excluded from analysis those that do not meet NICE criteria, pre-diabetes programmes, taster sessions etc.

19 The national picture Most (95%) CCGs commissioning some form of diabetes education. BUT around a quarter of CCGs not commissioning education for people with Type 1 often is being provided anyway? Data collection is patchy: over 50% of CCGs don t know how many people are attending some or all of their courses. Lack of monitoring to drive improvement? At least 56% of courses are commissioned via a larger block contract. Around 60% of courses are DESMOND, DAFNE or X-PERT the rest are lesser known or locally developed.

20 South West data: highlights Most CCGS are commissioning SDE for both T1 and T2: o 1 CCG not commissioning any SDE (except a T1 pump course and T2 pilot) o 2 CCGs not commissioning T1 education. Variety of different programmes, many locally-designed; around 70% commissioned through larger block contract. Most (9) CCGs supplied some attendance data - a lot of variation in numbers (e.g. max for T2 = 612, min = 102 per year) o One CCG could not supply any attendance data o One could not supply T1 data (but did have T2 figures) Five did not supply waiting list data for all courses. One CCG reported waiting time of months and 18 months+ for T1 courses (calculation based on numbers waiting and previous year s capacity).

21 Key messages FOI data suggests scope for improvement in most CCG areas: Need active commissioning of programmes for all people with T1 and T2. Data collection particularly around waiting times. QISMET accreditation of locally-designed programmes. Scope to move away from block contracts to establish KPIs and data collection.

22 Discussion Is Structured education a priority for your area? What barriers are you facing in your areas in relation to offer or uptake? How can we help you to overcome these? Commitment from individual CCGs to align with SW CV network commitment to increase by 10% year on year to March 2021 the number of newly diagnosed PWD attending a structured education course?