Dr Pete Davies; p.davies@nhs

1. Facilitating diabetes consultations through sharing blood test information- “Delivering results to you” Dr Pete Davies; p.davies@nhs.net

2. Facilitating Diabetes Consultations:Share Information. Empower people.

3. Reality Check The dogma: ‘Good’ diabetes is about ‘good self-care’ The mantra: “Understand diabetes. Take control” The reality: many barriers inhibit better understanding AND transfer of control/power

4. Engaged empowered patient Organised proactive system = Better outcomes Partnership How to get Better Outcomes in LTC

5. Engaged empowered patient Organised proactive system = Better outcomes Partnership Service redesign; QoF, etc. e.g. Diabetes education course ever offered: 2006- 11%; 2009- 13% All eggs in one basket? Lots of focus, attention and investment “Cinderella”

6. 3 % 0.03 % = 8,760 Self-care The average person with diabetes will spend three hours a year with a professional and the remaining 8,757 hours caring for themselves.

7. Care Planning • Usual care • Nurse/doctor led agenda • Telling e.g. results of tests, examination etc. • Judging • Prescribing • Proscribing • “thou shalt not” • Often time-constrained • Future care planning • Patient/client led agenda • Share results of tests and examination before the care plan meeting • Allow time for reflection • Patient is better prepared to discuss & agree a future treatment plan based on needs and choice

8. Communicating a measure of glucose control- HbA1c • A surrogate for glucose control • Useful clinically • BUT an abstract number, not easy to explain, or understand • Units of measurement about to change!

10. Innovation • When blood tests processed, send HbA1c result direct to person with diabetes • Ensure this is received within 5 days and before the care-planning review • Design the product in a way that • makes the result easy to understand • prompts positive health behaviours • Enhances the care planning process

11. Health Literacy Dimensions • Patient group consultation • Convey levels with colour ruler or traffic lights • Good control links to green, healthy plant/tree

12. Health Literacy Dimensions (2) • Internet communities: DAFNE-online (UK) & Tu-Diabetes (international) • Feedback on idea & options for graphics and text (Google Docs) via online survey tool

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

14. Descriptor text • Our aim- reading age as low as possible • Calculated reading age (MS Word) • Flesch reading ease score 62 • Flesch-Kincaid grade level 6.6 ‘easy to read’ for a 13-15 or 11 year old, respectively • Not bad for an abstract concept 

16. Design Features Coloured ruler scale Gives both present and previous results, showing trend Number and arrow match 3 simple categories Categories link to NICE targets for diabetes control Easy to understand descriptors for each category (irrelevant ones faded, to avoid confusion) Clear advice on what to do next- ‘pause, reflect.. bring to consultation’

17. Pilot results relevant to design, understanding & empowerment • Piloted n=1800 Dec 2010-Feb 2011 • 8 general practices & my specialist practice % agreed/strongly agreed • “Easy to understand” 72% • “Getting it before appointment helped” 73% • “Made it easier to talk to doc/nurse” 76% • “Would like again” 90% Free text: better medication adherence, diet, more physical activity, more interest in self-care

18. Summary & Conclusion • Patient involvement in design enhanced the quality of the product • enabling better understanding • As an aid to care planning, sharing information in this way • Was acceptable • Led to positive health behaviours, suggesting people have taken greater control of their diabetes • Enhanced consultations with doctors & nurses

19. Acknowledgements

20. Understand diabetes. Take control p.davies@nhs.net International Diabetes Federation & WHO