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![Page 1: “ Delivering results to you ” Share information. Facilitate diabetes care planning. Dr Pete Davies; p.davies@nhs.netp.davies@nhs.net Sandwell & West Birmingham.](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649d8c5503460f94a7367e/html5/thumbnails/1.jpg)
“Delivering results to you”
Share information. Facilitate diabetes care planning.
Dr Pete Davies; [email protected] & West Birmingham NHS Trust
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The Problem:• Diabetes care: often passive
– Are we surprised if appointments & tests are forgotten or missed?
• Cards stacked against patients– Professionals have the power & knowledge
and can prepare– Patients cannot easily be prepared
• We lack shared understanding– which tests matter? – What do the results mean?
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“Breaking bad news” in diabetes consultationse.g. HbA1c blood test results
• Similar to hearing negative feedback at performance review/appraisal
• Can’t take it in• Don’t hear anything else
that is said
There has to be a better way!
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To achieve better outcomes in Long-term ConditionsYou need all these components
Engaged empowered
patient
Organised proactive
system
Partnership
= Better outcomes
![Page 5: “ Delivering results to you ” Share information. Facilitate diabetes care planning. Dr Pete Davies; p.davies@nhs.netp.davies@nhs.net Sandwell & West Birmingham.](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649d8c5503460f94a7367e/html5/thumbnails/5.jpg)
Patients & Partnerships Overlooked
Engaged empowered
patient
Organised proactive
system
Partnership
= Better outcomes
Service redesign; QoF, etc.
Lots of focus, attention and investment“Cinderella”
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The average person with diabetes:
spends three hours each year with a professional
The remaining 8,757 hours, they care for themselves.
3
8,760
= 0.03 %
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Historical Diabetes Care
• Passive– Nurse/doctor agenda– Telling e.g. results of
tests, examination etc.– Judging– Prescribing &
proscribing • “thou shalt not”
– Often time-constrained
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To support Self Care
Get Active!– Patient-led agenda– Share information before the
care plan meeting– Allow time for reflection– Patient is
• better prepared
• Engaged
• An active partner
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Understanding Glucose control- HbA1c TestWe do not make it easy for patients!
• …a surrogate for glucose control
• …useful clinically
• BUT abstract, not easy to explain, or understand
• Units of measurement have changed!– 7% 53mol/mol
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Solution: When blood tests processed
• Send HbA1c result – direct to person with diabetes– Do so for everyone – Make it timely (before the care-
planning review)– Do so in a format that
• communicates meaning• promotes reflection & care planning
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Lean Six-sigma MethodologyKey Moments
Force-field analysis
Voice of the Customer Survey
Root Cause Analysis
Inventive
problem solving
Helped identify key enablers; helped us ‘manage’ resistors
Game-changer!Demand high
original idea (text message) NOT popular
Understanding of HbA1c is poor
Identified low health literacy
Product design would be critical
Incorporate low cost AND high quality-
The ‘Personal Mailer’
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Health Literacy & patient/user views
• Patient group consultation
• Online communities: DAFNE-online (UK) & Tu-Diabetes (international)– Feedback on idea & options for graphics and
text via online survey tool
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Professional Help
• One member of patient group was a graphic designer!
• Artwork ideas discussed with 2 independent graphic designers
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Descriptor text
Aim for a low reading age
– Calculated reading age =‘easy to read’ for a 13-15 or 11 year old, respectively
Not bad for an abstract concept
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Design FeaturesTrendpresent and previous results
Number and arrow
ScaleColoured ruler
3 categorieslinked to NICE & QoF targets
Clear advice “what next” ‘pause, reflect.. bring to consultation’
Goal setting & individualised targets
Signpost to lifestyle services
Simple descriptors
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Design FeaturesTrendpresent and previous results
Number and arrow
ScaleColoured ruler
3 categorieslinked to NICE & QoF targets
Clear advice “what next” ‘pause, reflect.. bring to consultation’
Goal setting & individualised targets
Signpost to lifestyle services
Simple descriptors
![Page 21: “ Delivering results to you ” Share information. Facilitate diabetes care planning. Dr Pete Davies; p.davies@nhs.netp.davies@nhs.net Sandwell & West Birmingham.](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649d8c5503460f94a7367e/html5/thumbnails/21.jpg)
Design FeaturesTrendpresent and previous results
Number and arrow
ScaleColoured ruler
3 categorieslinked to NICE & QoF targets
Clear advice “what next” ‘pause, reflect.. bring to consultation’
Goal setting & individualised targets
Signpost to lifestyle services
Simple descriptors
![Page 22: “ Delivering results to you ” Share information. Facilitate diabetes care planning. Dr Pete Davies; p.davies@nhs.netp.davies@nhs.net Sandwell & West Birmingham.](https://reader030.fdocuments.us/reader030/viewer/2022032705/56649d8c5503460f94a7367e/html5/thumbnails/22.jpg)
Outcomes of Design Work
• The result is meaningful– You don’t have to‘get it’ (i.e. understand A1c)
in order to know how your diabetes treatment plan is doing
• Now you have the meaning, you might just assimilate this into– positive health behaviours, – Engagement in care planning
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Does it work?Pilot Evaluation
• n=1800– 8 general practices recruited– 1 specialist practice (PHD)
• Evaluated by paired questionnaire• Administered at time of consultation• Patient and HCP gave their views• We could match the responses
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Results to Patients: patient benefits
Statement % Agreeing/ Strongly agreeing*
“Getting my HbA1c result before my appointment
helped me”
73%
“having my HbA1c result made it easier to talk to my
doctor and/or nurse”
76%
“I would like to receive my HbA1c result in this way in
future”
89%
“The fact my patient had their HbA1c result made the
consultation easier”
74%
Peo
ple
with
di
abet
es
Hea
lthca
repr
ofes
sion
als
*n=178 questionnaires returned for analysis
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Results to Patients: patient’s behaviour
Domain Patient comment
Medication adherence (concordance)
“getting my result made me take my tablets”
Dietary adherence “I’ve been trying hard with my diet, so this really gave me a boost”
Empowerment “I will go back to my nurse and ask to go on a diabetes course”
Confidence “I can now see that my treatment plan is really working!”
Peo
ple
with
di
abet
es
*n=178 questionnaires returned for analysis
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Results to Patients: benefits to diabetes team
Domain HCP comment*
Understanding diabetes “they wanted to know more about their result”
Engagement “before this it was difficult to get her to come”
Partnership working “after we’d discussed their result, they could see its value and were all for it”
Did this create time pressures? No extra time pressures
*n=17 professionals across 8 practices
Hea
lthca
re p
rofe
ssio
nals
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Present State• Successful roll-out
– December 2011, all Sandwell GP practices– Available to 20,000 people with diabetes
• Safeguard – exclude screening for diabetes
• High level of interest, other PCTs/CCGs and patients
• Support from my Trust– Sustainable & may be extended
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Summary & Conclusions• Patient involvement enabled product quality
• Sharing information in this way– Led to positive changes in health behaviours– Enhanced consultations/care planning,
suggesting partnerships were strengthened
• Suggesting people have understood & taken greater control of their diabetes
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Summary & Conclusions (2)
• We recommend Lean Six-Sigma methods for Quality improvement work
• Many other applications of this technology are feasible
• Easily transferable to other areas
• Lots of options for moving this into the digital health domain
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Acknowledgements
Mr Stuart Davis, type 2 diabetes 15 yrs, podiatrist 37 years, Sandwell PCTMs Dottie Tipton, Service Improvement Manager, SWBHDr Jenny Harding, pharmacist, Director of Clinical Governance Sandwell PCT
Thanks to Lilly UK for providing project support.Thanks to Sandwell Diabetes Support Group for financial support for the pilot
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Understand diabetes. Take control
Maybe initiatives like ours can help achieve that