Diabetes Prevention & Transformation

Diabetes Prevention & Transformation Dr Neel Basudev GP Lambeth Lambeth CCG Diabetes Lead Clinical Director Diabetes Health Innovation Network (South London AHSN) Co-chair South London Healthier You Partnership Board

Things to cover • Type 2 Diabetes Prevention Programme • Overcoming disengagement. How effective is primary care? • Diabetes Transformation

Care on the Frontline Type 2 Diabetes Prevention Programme

Evolution of Obesity

The Evidence Base

Drugs or diet to prevent diabetes? Gillies et al. BMJ 2007;334:299

Referrals into the programme Despite a slow start, partners in south London have exceeded referral targets consistently since January.

Uptake into the programme (uptake defined as attendance at initial assessment appointment) NHS England modelled that 40% of referrals would convert into an intervention. The average in south London currently is 57% - ranging from 25 - 92%.

Local Picture

Comparison

Flow chart

Coding and Feedback • Monthly Feedback • Minimal coding required • NDH register…metrics…referred & completed

The patient perspective • When we go to the course, we discuss things that motivate you. • The changes we’re making are really sustainable. It’s not about dieting and eating less, it’s about healthy alternatives and small lifestyle changes • I really look forward to the programme – it’s local, the coach is very friendly and helpful, and the materials we are given are very easy to use and understand • I’ve lost seven kilos so far • It’s been a real eye-opener. The coaches aren’t telling you what to do – it’s your choice

% breakdown of referrals attending an Initial Assessment (IA) by gender (as at 31.5.17)

% breakdown of referrals attending an IA by age-group (as at 31.5.17)

% breakdown of referrals attending an IA by ethnicity (as at 31.5.17)

% breakdown of referrals attending an IA by deprivation quintile (as at 31.5.17)

Care on the Frontline Overcoming disengagement How effective is primary care?

Non-compliance • “Act of obeying an order, rule or request” • Does this suggest collaboration? • Disengagement occurs at many levels • Patient (motivation, right place right time) • Provider (maintain momentum for all) • Commissioner (connective tissue) • HCP (quality of the “sell”) • What’s your sales pitch? Negotiator and salesperson

How to explain the obvious

Attendance at structured education • DESMOND • Non-attenders • lack of information/perceived benefit of the programme • unmet personal preferences • shame and stigma of diabetes • DAFNE • Non- attenders • Male • BME • Older age • Social deprivation • Attenders • Positive HCP message • Female • Educational attainment • HbA1c “To improve uptake at structured education we need to consider how health professionals in primary care communicate with their patients on the subject of structured diabetes education…. Health-care professional attitude to courses is key….”

“Words are of course the most powerful drug used by mankind” Rudyard Kipling

Any Data? • Let’s Prevent Diabetes • 6 hours group plus 3 hours refreshers at 12m+24m • Telephone calls every 3m • Cluster randomised 44 practices • 17,972 at risk population (risk score) • 3449 (19.2%) attended • 880 (4.9%) enrolled • 22% intervention arm did not attend initial session • 29% attended all 3 sessions • Overall: 26% RR developing T2DM • Full attendance: 88% RR developing T2DM

Care on the Frontline Diabetes Transformation

Overview

South London structured education Structured education hub To agree cross-charging for structured education courses, to enable patients to attend the right course at the right time and in the right location (i.e. to meet personal time and location commitments, language, cultural needs) – cross boundary access initially across South London and North West London – intention to later stretch pan London HCP education Design and deliver an education programme with strong consideration given to patient-led sessions and/or e-learning resources to include patient impact stories, motivational techniques, the importance of applying standardised data coding for referral, attended and completed; strengthening call and recall in primary care; developing diabetes care navigator/champion roles to maintain and sustain awareness of all of the above • Workforce ‘Think Diabetes’ initiative • To focus on STP partner organisations to deliver a ‘Think Diabetes’ initiative and review current HR policies, including: • Awareness raising of the importance of employees with diabetes attending structured education • Addressing gaps in HR policies to facilitate attendance at structured education Commitment across all elements to evaluation to support the sharing of learning and successful practice

South London Structured education Hub - COORDINATED SERVICE PROVISION Lifelong self- management support for individuals with Type 1 and Type 2 diabetes Structured Education Hub • Process and triage referrals • Conduct patient facing activities to review patient preference and activation level • Book courses and send patient reminders. • Signpost to other lifestyle services • Signpost to the latest diabetes apps and resources • Use data to conduct proactive outreach and case finding • Maintain an educator bank including peer educators • A website to promote life-long learning for patients, and support for clinicians • Collect and collate outcome data, then report this to primary care for recording and CCGs for demand and capacity analysis • Resources such as clinical e-learning modules and Think Diabetes Structured Education Hub Primary health care provider Structured education provider Primary health care provider • Refer to Hub from primary care, secondary care, or a community diabetes service • self-referral directly to the SE Hub encouraged Structured education provider • Receive referrals from the Hub • Provide structured education • Record outcome data and submits to SE Hub who then chase DNAs and submit outcome data to the primary health care provider and/or GP

Thanks for listening Questions?

Diabetes Prevention & Transformation