NHS Diabetes Prevention Programme Digital Stream Diane Powell (National Prevention Lead - Digital)
What are we doing with Digital to support Improvements in Diabetes Outcomes? Implementing digital behaviour change interventions aimed at preventing Type 2 diabetes in those already identified to be at high risk and evaluate their effectiveness; Improving the provision of information to support selfmanagement and care of people living with Type 1 diabetes; Scaling digital flexible learning resources to support management and self-care for people living with diabetes.
Background Digital Pilot Partnerships with 8 Local Health Economies (LHEs) North East London STP Digital only 5,000 places on Digital Behaviour Change Interventions (DBCI) Humber Coast & Vale STP Somerset STP Salford CCG Bristol, North Somerset, South Gloucester STP Lancashire & South Cumbria STP Buckinghamshire, Oxfordshire, Berkshire STP Central London, West London, Hammersmith & Fulham, Hounslow & Ealing Digital only Digital only Digital only Choice Choice Choice Refused face to face Tender exercise led to contract with Our Mobile Health to undertake App assessment. 87 EOIS, 30 digital interventions reviewed against the NHS Digital Assessment Framework. 14 digital interventions longlisted for consideration for pilot, 5 chosen to use for in-service evaluation. Open tender exercise led to contract with RSM the Delivery and Evaluation Partner to work alongside LHE s. MoUs with LHEs. RSM - sub-contracts with 5 final DBCI providers. RSM - sub-contract with Lloyds pharmacy.
Activity High Level Timeline Contract in place with a delivery and evaluation partner Mobilisation and implementation plans DBCIs identified to be used in pilot Date 19 June 2017 End of August 2017 Contracts with digital service providers in place 30 October 2017 Referrals to digital services commence By 30 November 2017 Data collection and activity reporting commence Jan/Feb 2018 Interim findings report October 2018 Final output report(s) assured and published September 2019
London Region Pilot Sites Site Provider North East London STP Liva Central London, West London, Hammersmith & Fulham, Hounslow & Ealing Oviva
Area Cohort Providers North East London 3 CCGs 15 GP practices Total population 750,000 Total - 1,100 uptake NDH 625 Overweight/obese - 495 Digital only Liva Healthcare (1,100) Mobilisation Mobilising GP practices to make referrals Operational work with Liva health coaches Communications & marketing Go live Jan 18
Area CWHHE 5 CCGs Total population 1.4m Cohort Providers Total - 500 uptake NDH 500 Refusal Oviva (500) Mobilisation Operational work with Oviva health coaches & ICS Communications & marketing Referrals via ICS commenced 9 Dec First Clinic 18 Dec
Recruitment Liva Healthcare (1 year programme) 1 2 3 Meeting Goal setting/plan Customisation Referral from GP or PR, brochures or other recruitment One-on-one introductory meeting (or digital meeting) Goals/plans are set and a relationship is established Platform is customised to the individual Lifestyle change: Diabetes prevention 6 Personal interaction: coaching/social interaction Healthcare professional Other patients 5 Tracking 4 X Y Z Daily tracking and registrations
Digital Provider - Oviva Frequent support and coaching offered by a dietitian for up to 6 months Support offered via: phone calls, text-message chat, smartphone app and online learning. Personalised nutrition and activity plan designed by dietitian. Goal Setting, Nutrition, Activity and Weight Tracked.
Digital Diabetes In-Service Evaluation Objectives: Provide DBCIs to reduce the risk of people developing type 2 diabetes. Aims: To test the effectiveness of DBCIs in reducing the risk of the user group developing type 2 diabetes, through encouraging behaviour change (dietary change, increased physical activity and weight loss). Target population: People (18+) identified at risk of developing type 2 diabetes where they meet any of the eligibility criteria: Present with non-diabetic hyperglycaemia (NDH) HbA1c of 42 47 mmol/mol (6.0 6.4%) or an FPG of 5.5 6.9 mmol/l Overweight BMI is equal to or over 25.
Primary Objectives of the In-Service Evaluation Are digital interventions effective in supporting behaviour change in those with non-diabetic hyperglycaemia (measured by reduction in weight and/or lowering of blood glucose as a minimum at 6 months and 12 months)? Are those same digital interventions effective in supporting behaviour change in overweight and or obese individuals who have not been diagnosed with NDH (measured by reduction in weight as a minimum at 6 months and 12 months)? What potential effect do these DBCI s have on health inequalities though: a) Access to the interventions and; b) Outcomes achieved as a result of receiving the interventions and; Can any conclusions be drawn about which groups would most benefit from the introduction of DBCI s? What are the potential costs of implementation and delivery of digital interventions and to where do costs accrue? What lessons can be learnt (positive and negative) about how the interventions have been implemented?
Secondary Objectives of the In-Service Evaluation What are the characteristics of digital interventions which appear to be the most effective/ have the most potential? And are any characteristics more or less effective for particular groups? How do the costs of different characteristics relate to the outcomes achieved? The following areas are not in scope of this project: - Comparisons of DBCIs to face to face interventions or comparisons of specific products - A comprehensive health economics assessment of the interventions.
Qualitative data 50 participant interviews on qualitative research questions, such as understanding personal experiences, key barriers, issues experienced, enablers etc. In-depth explanatory data from a small sample Understanding human behaviour Data will be coded and analysed by themes Illustrative explanations Face to face interviews with incentivisation for participants
Three areas have commenced referrals: CWHHE into Oviva Finally. Humber coast and Vale into LIVA & OurPath Bristol OurPath Remaining areas looking to start referrals asap for individuals to commence services in January.
Thank You diane.powell@nhs.net Memuna.adam1@nhs.net