Improving Diabetes Care at RBFT Dr Ian Gallen 5 May 2016 What is - - PowerPoint PPT Presentation

Improving Diabetes Care at RBFT

Dr Ian Gallen

5 May 2016

What is Diabetes?

• Diabetes is a common life-long health condition. There are 3.5 million

people diagnosed with diabetes in the UK and an estimated 549,000 people who have the condition, but don’t know it.

• Type 1
• Type 2
• Secondary to other diseases
• Rare types

• Without appropriate self, professional support and access to best treatments, diabetes

is associated with – Early death – Life altering complications

• Blindness
• Kidney failure
• Limb amputation
• Pain
• And many other problems
• Which are largely avoidable

Why does management of diabetes matter?

Need for Change?

• Local
• Poor performance in care processes and cost/outcomes
• Glycaemic control was poor (46.8% vs. 56.8% nationally achieving HbA1c<60mmol/mol)
• 2 x progression to renal replacement, and high DKA admission
• Majority of care provided at GP practices by GPs and Practice nurses, unsupported
• No community DSNs
• Insufficient capacity in diabetes centre
• National
• Increasing incidence
• Increasing obesity
• Increase in frail elderly
• Need to reduce hospital admissions and develop other pathways of care

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Redesign of services

• External consultancy
• Local champion appointed
• Stakeholder network established
• Collaboration across organisational boundaries: acute trust, CCGs,

community provider, public health, patients

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Service developments

• Structured patient education
• X-PERT for Type 2
• DAFNE for Type 1
• CarbAware 3-hour carbohydrate counting courses for Type 1 patients
• Care planning
• 3 local HCPs trained to deliver training and facilitate implementation of the House of Care model
• HCP education: Foundation Course, plus an advanced course in injectable therapies called PITstop
• Deployment of DSNs to the community (1 for each of the 4 CCGs)
• Care pathway and treatment guidelines development
• Introduction of Eclipse, a cloud-based IT system to facilitate audit, risk stratification and provide a patient portal
• Website for patients, carers and HCPs www.berkshirewestdiabetes.org.uk
• Appointment of a specialist diabetes consultant in the community
• Virtual clinics in GP surgeries providing case review and HCP education
• Seamless contact for GPs and practice nurses for advice
• 2 new RBH consultants and reconfigure secondary services to focus on “super-6”

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Care for Diabetes in Berkshire West

Diabetes Specialist Nurses

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3rd sector support

• DUK

X-PERT CarbAware Talking health DAFNE Care planning Website Stakeholder network Metrics & monitoring - Eclipse Eye screening Dietetics Podiatry Monthly newsletter HCP Education Community specialist Virtual clinics Website Meds management

Coherent commissioning led by network supported by Central Support Unit

What services does RBFT offer

• Emergency and post emergency care for people with diabetes
• Melrose House (recent CQC review reports as excellent)

– Specialist diabetes clinics – Insulin pump and continuous glucose monitoring – Adult education

• Specialist services

– Foot clinics – Vascular services – Pregnancy services – Dialysis

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CarbAware course for Type 1 DM

• Problem
• 600 people with T1DM needed adult education to improve control in

Berkshire West

• DAFNE started but is limited by cost and staff
• Difficult to attend a 5 day course
• Solution
• Designed and delivered a structured 3 hour group teaching program
• So far
• 65 courses, 320 participants

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HCP Education

• Foundation course - developed by local team - 66 attendees both GPs

and PNs

• PITstop – national injectable therapies initiation course delivered

locally with local DSN mentor, 54 attendees

• Half-day workshops – facilitated by MDT to meet the needs found in

local surveys: oral therapies, insulin optimisation, renal diabetes

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Virtual Diabetic Clinic

• MDT in practice to review diabetes cases
• Patients who require review identified by Eclipse. Highest priority is patients with

very poor diabetic control (HbA1c>85mmom/mol)

• Outcome of the virtual clinic recorded for implementation in the care planning process
• Reviews of therapy
• Adult education
• Review by the DSNs in practice
• Review by specialist or Bariatric team

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Progress to date

• Mean HbA1c reduction of 5.35mmol/mol between 06/12 and 06/14 (60.49 to 55.14

mmol/mol)

• Proportion achieving HbA1c <60mmol/mol increased from 46.5% (06/12) to 57.6%

(06/14)

• Initial data shows HbA1c reduction of 18% among X-PERT attendees: 67.5mmol/mol

before course, 55.5mmol/mol 6 months after X-PERT

• Proportion achieving total cholesterol <5mmol/l increased from 46.3% (06/12) to 79.2%

(06/14)

• Proportion achieving BP ≤ 140/85 from 66.2% (06/12) to 78.0% (06/14)
• Prescribing savings of £805,000 since 2012 resulting from the reversal in the trajectory
• f increasing cost of diabetes medications:
• £313 (2011/12)
• £283 (2012/13)
• £269 (2013/14)

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Achievement of 8 care processes by CCG 2010-2013 (NDA data)

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Treatment target achievement rate for all 8 care processes 2010-2013 (NDA data)

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Development plans

• Elderly and housebound
• Diabetes in pregnancy
• Young person with diabetes
• Increasing provision for insulin pump treatment
• “Frequent Flyer“ hypoglycaemia service
• Islet cell transplant satellite service
• New services for young Type 2 diabetes

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Conclusion

• Massive improvement in diabetes care in Berkshire
• But as diabetes becomes more common, and treatments become

more complex need – More specialist in diabetes, especially nursing staff – More space, Melrose house need to be expanded

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