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Structured Education in the UK What you are telling us…. Type 1 Education Network. Total programmes presented today. 23 adult Type 1 4 paediatric 11 adult type 2 . Type 1 programmes. Patients per year 12 – 100 Education per patient 5 – 40 hours Time period 5 days – 8 weeks

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Structured education in the uk what you are telling us l.jpg

Structured Education in the UK What you are telling us….

Type 1 Education Network


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Total programmes presented today

  • 23 adult Type 1

  • 4 paediatric

  • 11 adult type 2


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Type 1 programmes

  • Patients per year

    12 – 100

  • Education per patient

    5 – 40 hours

  • Time period

    5 days – 8 weeks

  • Trained educators per centre

    2 – 15


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Length of Type 1 programmes

  • 1 DAFNE national (68 centres) + 1 local (5 days)

  • 16 run 1 day a week over 3 – 5 weeks

  • 4 run 3 – 8 sessions over 3 – 8 weeks

  • 1 is research project


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Programmes

  • ADC (Advanced Diabetes Course) Redhill

  • ASPIRE (A Skills Programme in matching Insulin Requirements to Eating and exercise) Chesterfield

  • BERTIE in Essex Chelmsford EDWARD (Education for Diabetes Without Restricted Diet) Nottingham

  • BERTIE (Bournemouth Type 1 Intensive Education)

  • BRUCIE (Better Regulation Using Carbohydrate and Insulin education) Ayr PDAC (Peterborough Dose Adjustment Course)

  • CHARLIE ( Charing Cross and Hammersmith Advanced Resource for Living with Insulin and Eating)


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Programmes

  • CHOICE (Carbohydrate and Insulin Calculation Education) Windsor

  • DAFNE

  • DIANA ( Daily Insulin Adjustment to Nutrition and Activities) Mile End, London Freedom 4 Life Bath

  • Gift (Gateshead Insulin and Food training)

  • ICG (Intensive Control Group) Royal Free, London

  • JIGSAW (Juggling Insulin for Goals Success And Well-being) Portsmouth

  • NICER (Northern Ireland Carbohydrate Educational Resource) Belfast


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Programmes

  • PDAC ( Peterborough Dose Adjustment Course)

  • PRINCESS ( Princess Royal Insulin and Carbohydrate Estimation Skills) Haywards Heath

  • REACCT (Re-Education and Carbohydrate Counting Training) Gloucester

  • Skills for Life Bristol

  • TIEP (Type 1 Education Programme) Frimley Park)

  • TOPUP (Type One Diabetes Programme – Understand and Progress) Newcastle

  • WINDFAL (Whittington Insulin Dosing for Active Living)


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Type 1 network programmes


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Health professionals involved

  • DSN’s

  • Specialist dietitians

  • Consultants

  • Clinical psychologist

  • Educational psychologist

  • Health informatics expert

  • Podiatrist


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Meeting NICE Criteria

  • Philosophy: 21 yes, 1 developing, 1 no (research project)

  • Educational theories: 23 identified their theories (16 use social learning theory)

  • Written curriculum: 21 yes, 2 no

  • Quality development: 13 yes, 3 in development, 7 no

  • Audit: 20 yes, 3 no


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Comments

  • We have a type 1 education programme available to our patients that meet the NICE criteria

  • Recognised by PCT as providing appropriate structured educational model for people living with type 1 diabetes

  • Now able to offer structured education to large numbers of people with diabetes


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Results

  • 14 make direct quotes from participants and another 6 comment about improved QOL

  • HbAIc reduction

  • Patients achieving their goals

  • Reduced insulin requirements

  • Improved awareness of hypoglycaemia

  • Reduced frequency of hypoglycaemia

  • Weight loss


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Achievements

  • Collaborating with sculptor to make work of art about experience of living with diabetes

  • Many letters of support to chief executive who now wants to attend course

  • Congratulated by PCT for contribution to healthcare commission

  • Winning Arun Baksi Award

  • Influence of programme in decision to build Healthy Living Centre


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Common themes

  • Information/support gained through T1EN

  • Attendance of partners

  • Community setting

  • Psychological input

  • Reference to other programmes e.g newly diagnosed

  • Programme developed without additional resources

  • Low drop out rate


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Issues raised

  • Intensive education a requirement before starting pump therapy (sometimes pump no longer needed)

  • Follow up/reviews

  • Shorter time frame versus some programmes have lengthened the time


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Issues raised

  • Educational process needs to be ongoing

  • Programmes need to be updated

  • Change of concern from hypoglycaemia to concerns about mood and living with diabetes

  • Training other health professionals

  • Importance of consultant support


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Ideas

  • Use of reflection diary with patients

  • Insulin profile graphs/insulin ratio tables/insulin dose credit cards

  • Supermarket tour

  • Other health professionals attend course to gain understanding


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Concerns

  • Waiting list

  • Lack of funding for programme and admin to collect data


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Paediatric programmes

  • Flexible Adjustment of Basal Bolus (FABB)

  • Kids In Control Of Food (Kick-Off)

  • FACTS

  • Structured Education for Pumps (StEP)


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FABB – Leicester Royal Infirmary

  • 79 children/young adults from January 07

  • 5 hours education per course (2 x 2½ hours over 2 weeks)

  • 4 fully trained educators, all FABB aware

  • Positive feedback and reported improvement of QOL

  • Rewarding for team despite steep learning curve


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Extra programmes

  • Little FABB (under 5’s)

  • Extra FABB (special needs)

  • FABB for pumps

  • FABB for free mixing

  • PreFABB for MDI

  • FABB follow up


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FACTS – Ipswich NHS Trust

  • First programme September 03

  • 78 families have attended

  • 6 x 1½ hours education over 6 months

  • 12 trained educators

  • Refined FACTS 2 starting as RCT in Norwich, Peterborough, Coventry, Nuneaton, Leicester, Dorset, Poole and Portsmouth


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Proud of

  • Programme could be beneficial if integrated into routine paediatric care

  • Secured funding to develop both programmes and comprehensive evaluation

  • Incorporates practical skills training with behavioural modification

  • Results have been presented at DUK and published in Diabetes Care and diabetic Medicine


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KICK-OFF

  • Pilot recently completed, awaiting funding for RCT

  • 2 age bands 11 – 13 and 14 – 16

  • 32.5 hours education per course over 5 days

  • 3 educators per course


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Proud of

  • Pilot study was well evaluated by children, friends and family

  • Web-based programme being developed to support course

  • Pilot study showed improved QOL but no change in HbAIc or BMI

  • Won Diabetes UK education award in 2006


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STeP – Leeds Teaching hospitals Trust

  • Developed over last 5 years for children starting pump therapy

  • 15 patients per year

  • 6 – 12 hours either consecutive days or within 4 day period

  • Web-based programme developed to compliment programme


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Proud of

  • Collaboration and support from a parent support group

  • High level of satisfaction from children and families

  • Each member of team involved

  • Clinical educator appointed to lead further developments, quality assurance and audit


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Type 2 programmes

  • 2 national programmes- Desmond and X-PERT

  • 4 local DESMOND

  • 1 X-PERT adapted in Hindi or Punjabi

  • 4 local programmes

  • 1 pilot due to start January 2008


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Type 2 programmes

  • Patients per year

    100 - 900

  • Education per patient

    6 - 14 hours

  • Time period

    1 day – 7 weeks

  • Trained educators per centre

    1 – 22


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Meeting NICE Guidelines

  • Philosophy: 10

  • Educational theories: 10

  • Written curriculum: 10

  • Quality development: 10

  • Audit: 10

  • Research project starting in January


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DESMOND

  • RCT – January 2004

  • National roll out – January 2006

  • Average 10 participants + partner per session

  • 6 hours education delivered over 1 full day or 2 half days


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67 PCT’s offer DESMOND

377 trained educators

24 trainers and

assessors

673 attended RCT)

?10,000 attended so far


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X-PERT

  • RCT 2001

  • Implemented 2005

  • 14 hours of structured education over 14 hours

  • East Lancashire PCT have 18 educators

  • Nationally 521 educators


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1,539 attended since RCT


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Results

  • Mean participant evaluation score 93%

  • 17% (23%) increase in empowerment score at 6 (12) months

    At 6 months

  • 0.6% reduction in HbA1c

  • 3.1 Kg weight loss (3.9Kg at 12 months)

  • 2.5cm reduction in waist circumference


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3 local DESMOND

  • Peterborough

  • Wakefield District and North Kirklees Diabetes Network

  • East Surrey PCT and Surrey and Sussex NHS Trust


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Aap Ki Sehat Aap Ke Haath

  • Hounslow NHS and West Middlesex University Hospital, Isleworth

  • Adapted from X-PERT

  • 148 patients (July 06 to June 07)

  • 5 sessions of 2 hours over 5 weeks

  • 1 educator


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Results (6 months)

  • Excellent attendance

  • Decrease HbAIc 0.13%

  • Decrease in BMI 0.14%

  • Decrease 1.6%

  • Good feedback


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Bristol and South Gloucester PCT’s and North Bristol NHS Trust

  • First course August 2005

  • 800 patients per year

  • 9½ hours education over 1½ days

  • 22 trained educators (practice nurses, DSN’s, primary care dietitians, podiatrists, community pharmacist


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Proud of

  • Developing local staff in primary care to deliver programme

  • Offering courses in a variety of locations

  • Robust QA process

  • Developing ‘confidence to self-manage tool’


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Dorset

  • Poole Hospital NHS; Bournemouth and Poole PCT

  • Both programmes have open-access within 1 week of diagnosis

  • 500-900 patients per year

  • Poole Hospital audit data shows mean HbAIc reduction of 2% in first 3 months


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Whiston Hospital, Merseyside

  • BENDS 2 pilot August 06, implemented January 07

  • 780 patients first year

  • 12 hours education (3 hours over weeks)

  • 14 trained educators

    Proud of whole suite of education programmes that cater for needs of local population. Young, old, educated and uneducated engage and enjoy the programmes


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Diabetes Education through Adult Learning (DEAL)

  • Bend 1 – basic education for newly diagnosed type 1

  • FETCH 1 – further education type 1

  • FETCH 2 – further education for type 2

  • ICE – insulin carbohydrate education

  • FLEX – individual education for people with specific needs


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Structured Education in the UK What are you telling us?

  • We have made lots of progress since NICE guidelines in 2003

  • Many of you have put a lot of work and effort in

  • Many achievements


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Summary

We are proud to be changing tradition and making a

difference to people’s lives


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Summary of structured education in UK

  • Some areas in UK still have very little structured education

  • Some have started structured education but now need to make it part routine clinical care

  • Some have incorporated programmes into routine care and looking at other areas


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Challenges

  • Funding

  • Paediatric programmes

  • BME programmes

  • Record of programmes


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Conclusion

Well done to everyone BUT we still have a long way to go before everyone with diabetes in UK has access to structured education


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