“ Delivering results to you ” Share information. Facilitate diabetes care planning.

“Delivering results to you”Share information. Facilitate diabetes care planning. Dr Pete Davies; p.davies@nhs.net Sandwell & West Birmingham NHS Trust

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?

“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!

To achieve better outcomes in Long-term ConditionsYou need all these components Engaged empowered patient Organised proactive system = Better outcomes Partnership

Patients & Partnerships Overlooked Engaged empowered patient Organised proactive system = Better outcomes Partnership Service redesign; QoF, etc. Lots of focus, attention and investment “Cinderella”

3 0.03 % = 8,760 The average person with diabetes: spends three hours each year with a professional Professional care Self care The remaining 8,757 hours, they care for themselves.

Historical Diabetes Care • Passive • Nurse/doctor agenda • Telling e.g. results of tests, examination etc. • Judging • Prescribing & proscribing • “thou shalt not” • Often time-constrained

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

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

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

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’ Lean Six-sigma MethodologyKey Moments

TIMELY • PUSH

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

Professional Help One member of patient group was a graphic designer! Artwork ideas discussed with 2 independent graphic designers

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 

Design Features Trend present and previous results Number and arrow Scale Coloured ruler 3 categories linked to NICE & QoF targets Clear advice “what next”‘pause, reflect.. bring to consultation’ Goal setting & individualised targets Signpost to lifestyle services Simple descriptors

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

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

Results to Patients: patient benefits People with diabetes Healthcare professionals *n=178 questionnaires returned for analysis

Results to Patients: patient’s behaviour People with diabetes *n=178 questionnaires returned for analysis

Results to Patients: benefits to diabetes team Healthcare professionals *n=17 professionals across 8 practices

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

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

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

Acknowledgements Mr Stuart Davis, type 2 diabetes 15 yrs, podiatrist 37 years, Sandwell PCT Ms Dottie Tipton, Service Improvement Manager, SWBH Dr 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

Maybe initiatives like ours can help achieve that Understand diabetes. Take control p.davies@nhs.net

“ Delivering results to you ” Share information. Facilitate diabetes care planning.