dr pete davies; p.davies@nhs

Facilitating diabetes consultations through sharing blood test

information- “Delivering results to you”

Dr Pete Davies; p.davies@nhs.net

Facilitating Diabetes Consultations:

Share Information. Empower people.

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

How to get Better Outcomes in LTC

Engaged empowered

patient

Organised proactive

system

Partnership

= Better outcomes

All eggs in one basket?

Engaged empowered

patient

Organised proactive

system

Partnership

= Better outcomes

Service redesign; QoF, etc.

e.g. Diabetes education course ever offered:

2006- 11%; 2009- 13%

Lots of focus, attention and investment“Cinderella”

Self-care

The average person with diabetes willspend three hours a year with aprofessional and the remaining 8,757hours caring for themselves.

3

8,760=% 0.03 %

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

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!

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

Health Literacy Dimensions

• Patient group consultation– Convey levels with colour ruler or traffic lights– Good control links to green, healthy plant/tree

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

Professional Help

• One member of patient group was a graphic designer!

• Artwork ideas discussed with 2 independent graphic designers

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

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’

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

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

Acknowledgements

Understand diabetes. Take control

International Diabetes Federation & WHOp.davies@nhs.net