Service innovation to help people live well with diabetes and reduce sight loss Helen Lee RNIB

1. Service innovation to help people live well with diabetes and reduce sight lossHelen LeeRNIB

2. Why the focus on diabetes? • Diabetes is the leading cause of preventable sight loss amongst the working age population • 2,690 people were newly certified as visually impaired due to diabetic eye disease in England and Wales in 2013/14 • 2.8 million people diagnosed with diabetes in England • 400,000 living with undiagnosed diabetes • People living in deprivation; people of South Asian, black African and Caribbean ethnicity are more at risk of diabetes and diabetic eye disease

3. Aims To increase: • Attendance at DRS, eye examinations, secondary care diabetic eye clinics • Understanding of eye health and its relationship to diabetes Original target population was people of Pakistani heritage 40 to 65 living with diabetes in Keighley Some of the initiatives targeted people of all ethnicities in Bradford living with diabetes.

4. Our approach in Bradford • Analysis routine data - eye health equity profile • Qualitative research with service users, providers & public • Co-production of solutions • Testing interventions (18 months) - Pakistani community • Roll out - 12,000 patients of all ethnicities • Refine • Disseminate learning

5. What people told us • Diabetes is complicated: • To understand • To manage • People struggle with information, results and appointments • People often have a sense of fatalism and don't understand prevention • People get confused about the eye tests and screening

6. Suite of interventions • 400 Pakistani people living with diabetes received a Living Well with Diabetes self management folder • Health professionals & community activities gave consistent messages • Awareness raising in the community - Tether my camel • Text appointment reminder sent by DRS to everyone • A bilingual administrator phoned to remind people to attend secondary care appointments

7. Living Well with Diabetes • Self management folder to: • Facilitate a coaching conversation • Help organise appointments & information

8. Consistent key messages - optometrists - pharmacists - community and religious leaders

9. London School of Hygiene & Tropical Medicine Evaluation methods • Routine DRS data • Logs mobile phone coverage & recall text reminders • Pre- and post-intervention postal questionnaire to patients via GP Practices • Qualitative interviews with professionals and patients

10. Results • 15% increase in attendance at Diabetic Retinopathy Screening (DRS) amongst Pakistani patients who had folder • 10% increase in attendance at DRS overall • A 23% increase in understanding about the need to check blood sugar and attend appointments to reduce the risk of complications • A 15% increase in understanding of the need to attend both eye examinations and DRS

11. People with diabetes spend 8,760 living with their condition and only 4 hours a year with health professionals.Improving self management is essential to reduce complications including sight loss.

12. Key to success • Whole systems approach • Primary care, DRS, hospitals and community all working together to give consistent messages • Using motivational interviewing to support people • Whole team approach within primary care • Improving appointment systems

13. We've found a way of implementing self care that actually makes sense to those people who have the conditionGreg Fell Consultant in Public Health Bradford

14. Winners of Quality in Care Diabetes 2015 best initiative supporting self care Funding from: • Department of Health • RNIB • Bradford District, City and Airedale Clinical Commissioning Groups Partnership working - community, primary care, commissioners, hospital services, DRS

15. More information • www.rnib.org.uk/living-well-with-diabetes • Helen Lee helen.lee@rnib.org.uk