Using HTA to Inform Policy and Practice in Newfoundland and Labrador 2015 CADTH Symposium Sheila Tucker, M.L.I.S., B.Ed., B.A. (Hon), CPAD. – CADTH

Disclosure – Sheila Tucker

Relationship with Commercial Interest:

• Grant/Research Support: None

• Speaker Bureau/Honoraria: None

• Consulting fees: None

• Memberships on advisory committees, boards: None

Other Affiliations:

• I am a CADTH employee independently located in Newfoundland.

Objectives

• Describe the local context and approach to outreach and knowledge exchange.

• Share the information and evidence used to inform policy and practice change.

• Discuss early experiences and impact.

Partners

Blood Glucose Monitoring in Long Term Care

• Project leaders:

– Kelli O’Brien, Vice-President of Long Term Care and Rural Health, Western Health

– Heather Brown, Vice-President of Rural Health, Long Term Care, and Community Supports, Central Health

• Project teams at Western Health and Central Health, Newfoundland

Strengthened Customer-facing

Support

Committee/Association Relationships

National Network

Integrated KT

Identification of Knowledge/ Practice Gaps

Pan-Canadian KM Planning

National Partnerships

Key Message +Tool Development

Jurisdictional Network

Individual Customer/ Stakeholder Relationships

Direct Customer Interface

Identification of Context Specific Needs

Local Partnerships/ Opportunities

Topic Identification

Implementation Support

responsive, nimble, customized

A

Awareness & Relationship Management

Knowledge Mobilization & Strategic

Linkages

B

Capacity Building C

Outreach Event Management D

Impact / Value for Money E

CADTH’s Outreach Program: KMLO

Location of Long Term Care Facilities in

Newfoundland and Labrador

CADTH Evidence on Blood Glucose Monitoring

Outreach in Newfoundland and Labrador

• Self-monitoring of blood glucose in diabetes management.

CADTH (2009)

• Outreach and knowledge exchange activities in

Newfoundland and Labrador (general population)

• Questions raised about sub-groups of patients with type 2

diabetes

• Long term care?

• CADTH Rapid Response report (2010)

Rationale for this Initiative

• Aging Population ↑, Diabetes Prevalence ↑

• Evidence of sub-optimal use of test strips in diabetes

management

• New guidelines

• Role of blood glucose testing in diabetes management

being reconsidered

Releasing Time to Care

Goal:

• Implement best practice in the care of residents with type 2 diabetes.

Anticipated Benefits:

• Supports resident and family-centred care

• Improved assessment skills for care providers

• Less stress and pain for residents

• Improved utilization of resources

• More time and resources for improving the resident experience

• Monitoring foot, dental, and vision health, and A1C.

• Individualized care.

• Well-being, quality of life

Western Health and Central Health

Roles

• Leadership

• Project planning and management

• Stakeholder engagement

• Identification of knowledge gaps

• Adoption of new policy and practice

• Evaluation

• Dissemination

Project Advisory Committees

• Comprised of long term care and diabetes stakeholders

• Front line clinicians

• Critical in providing local, clinical perspective, review and

feedback on evidence, information, and clinical practice

tools.

• Facilitated ownership and adoption of the practice change.

CADTH’s Role

• Liaising with project stakeholders

• Working in collaboration and consultation with the project

leads to:

• Develop presentations to profile the existing evidence

• Outreach to CADTH networks across Canada / informal

scan to identify existing relevant policies and practice

guidelines

• Addressing knowledge gaps

Evidence and Information

Used in the Projects

• Baseline utilization data

• Informal cross-country scans

• Canadian Diabetes Association – 2013 Guidelines for

Diabetes in the Elderly

• Clinical experts

• Accredited webinar

CADTH Rapid Response Report: Management of Diabetes

in the Long-Term Care Population: A Review of Guidelines

(2013) – Summary with Critical Appraisal

What are the evidence-based guidelines for the monitoring of blood glucose for patients with diabetes in the long-term care population?

• Two evidence-based clinical practice guidelines retrieved;

• Suggested laboratory tests be performed when diabetes is suspected.

• Levels of glucose (fasting blood glucose or HbA1c) are recommended to be tested every 3 to 6 months, however the frequency of the blood glucose monitoring should be individualized.

CADTH Rapid Response Report: Glucose Replacement

Agents in Frail Elderly Patients with Type II Diabetes in

Long-Term Care: Clinical and Cost-Effectiveness, Harms,

and Guidelines (2015)

Summary of Abstracts

Q1. What is the clinical effectiveness of glucose replacement

agents in frail elderly patients with type II diabetes who reside

in long-term care (LTC) facilities?

Q2. What are the harms associated with glucose replacement

agents in frail elderly patients with type II diabetes who reside

in LTC facilities?

Glucose Replacement Agents in Frail Elderly Patients with

Type II Diabetes in Long-Term Care: Clinical and Cost-

Effectiveness, Harms, and Guidelines (2015) - Continued

3. What is the cost-effectiveness of using glucose replacement

agents in frail elderly patients with type II diabetes who reside

in LTC facilities?

4. What are the evidence-based guidelines regarding the use

of glucose replacement agents in frail elderly patients with

type II diabetes who reside in LTC facilities?

Results:

• No evidence, however…

Clinical Practice Tools

Developed/customized in consultation with project

teams:

• Resident / family pamphlets

• “Reducing Blood Glucose Testing for Residents With Type 2

Diabetes in Long Term Care”

• “Stop Hypoglycemia” (new tool)

• Clinical practice guidance card

• Poster

• Pocket card

Education and Change Management

• Two new policies:

• Blood Glucose Monitoring;

• Glycemic Control in the Frail Elderly

• Staff education sessions

• Clinical Order Sets

• Letters to physicians, other stakeholders

Early Experiences

Central Health and Western Health

• Enhanced knowledge, networks - “we are not alone”.

• Skill development - evidence informed decision

making processes.

• Time commitments required for partnerships, practice

and policy change.

Capacity Building

• Two-way • RHA capacity HTA use

• CADTH capacity to engage with front line healthcare practitioners to fully understand needs, perspectives

• Team approach to addressing emerging questions and challenges

• Importance of ongoing service support/continuity

CADTH is helping us to develop the skills and build the confidence of our people to critically appraise, contextualize, and use the evidence. HEATHER BROWN, Central Health, NL

Going Forward

RHA Plans

• Evaluation

• Dissemination

• Future initiatives to improve practice in other settings

• Opportunities to address research gaps

Acknowledgements

• Kelli O’Brien, Western Health

• Heather Brown, Central Health

• Project advisory committees at Western Health and Central

Health

• Rapid Response Team, CADTH

• Knowledge Mobilization, CADTH

Photo provided by Western Health

Releasing Time to Care Stay Tuned for Future Updates – Thank you!