newbury pre diabetes project - berkshire west ccg
TRANSCRIPT
Newbury Pre Diabetes Project A real-world implementation of QDiabetes in a CCG Area
Tim Walter
Newbury and District CCG
Raise awareness generally
Lifestyle intervention for those at risk
Early identification of those at risk of, or already with DM2 without a diagnosis
Aims of the PreDM Project
My Journey
Newbury Pre-Diabetes Project
Phase 1 Lifestyle Intervention - Surgeries
Phase 2 County Show experience
Phase 3 Targeted screening
As an example to copy/change as you wish
Resources www.predm.co.uk
What to expect from today
Trends at Falkland Surgery
2000 Type 1 DM = 44 Type 2 DM = 150 (194)
2005 Type 1 DM = 56 Type 2 DM = 250 (306)
2008 Type 1 DM = 66 Type 2 DM = 369 (435)
2012 Type 1 DM = 73 Type 2 DM = 399 (472)
12/11/2013 Total 498
The massive increase in DM is predominantly in the Type 2 group
About 3.5% of population
Summary of historic care
1990’s – minimise impact (Symptoms and meds)
2000’s – move to targets and “maximize dose” and identify missed diagnosis
2010’s – earlier diagnosis (seeking borderline results) of pts with IGT, single Random BS readings etc
Inaugural joint 2012-13 winners
Funded by QResearch ( in a joint partnership between Emis, Emis NUG and University of Nottingham)
Prof. Aziz Sheikh of Primary Care Research & Development at the University of Edinburgh – Smoking Cessation
Myself – Pre-Diabetes Project
Plus John Robson and Kambiz Boomla
QInnovation
Nice Guidance
Recent National Institute for Health and Clinical Excellence (NICE) guidance has recommended:
• Identifying people at risk of developing type 2 diabetes, using a
validated risk assessment score and a blood test (fasting blood glucose or HbA1c) to confirm high risk.
• Providing those at high risk with an intensive lifestyle-change
programme to prevent or delay the onset of type 2 diabetes.
Recommendation 3 Developing a local strategy
Recommendation 6 Conveying messages to the local population
Recommendation 8 Promoting a healthy diet: local action
Recommendation 10 Promoting physical activity: local action
Nice PH35 Preventing type 2 diabetes: population and community-level interventions
reduce their weight by more than 5%
keep their fat intake below 30% of energy intake
keep their saturated-fat intake below 10% of energy intake
eat 15 g/1000 kcal of fibre or more
are physically active for at least 4 hours per week.
Finnish Diabetes Prevention Study
QDiabetes Tool
Concept of Pre-Diabetes
Early intervention reduces risk by up to 60% (Finnish Study and DPP in USA)
Lifestyle interventions (E4H) work in the short term
Project looks to combine these to assess practical issues and costs
Components of the project
113,000 - mixed clinical system CCG
Surgery Process, 1st cohort EmisWEB
Instructions to practices to run the bulk QDiabetes module
Identify patients with > 30% 10yr risk
Invitation to have bloods and join E4H Group
Currently ending 2nd Cohort phase, LV and INPS
Starting SystmOne and last EmisWEB practice
Newbury PreDM Project
50 patients invited per practice (8 surgeries) (30-80% risk calculations)
400 in first 2 cohorts
18% uptake
Of those having bloods 14% at diagnostic levels, more with marginal results
E4H – Average 3kg Weight loss, = 110Kg total in 1st cohort
Up to 15Kg loss
1kg =16% risk reduction in DM
Surgery Phase 1st and 2nd Cohort Results
Admin charge 150
E4H staff cost 400
Accommodation 400
Total cost therefore 1000 per practice
Approx benefit – 1DM, average 3kg weight loss per participant, raising profile etc
Surgery Phase - Costs per practice
60,000 attendees
21-22nd September
2 clinicians doing QDiabetes Screening
2 PH Nurses doing HbA1c for those with high scores
3 E4H staff giving advice, BCA and enrolling to E4H Sessions
Newbury Show
Newbury Show Pre-Diabetes Stand During a quiet spell!
Newbury Show Stand
Potential Audience of 60,000
310 Screened via QDiabetes on iPads
111 targeted HbA1c tests done (Approx 1/3rd)
80 Body Fat/Composition Measurements
30 people signed up for E4H classes
5 New diabetics (up to HbA1c = 64) plus 5 HbA1c 42-47
NB Health Promotion vs Detection
Newbury Show - Results
Is it financially worthwhile Breast screening
2 million women
15000 diagnoses
96 million pounds
50 pounds per screen
6000 pounds per diagnosis
Is it financially worthwhile Cervical cancer
5 million invites
3.5 million tests
200,000 abnormals
4000 cancers prevented
175 million pounds
About 1000 pounds per abnormal, and about 40,000 pounds per cancer prevented
Is it financially worthwhile ??? Diabetes – Newbury Show
60,000 attendees
310 screened with QDiabetes
111 HbA1c tests
5 New Diabetics
Cost per diagnosis 1000 pounds
Trial this weekend at Falkland Surgery
266 pts with Risk > 15% (without recent bloods done)
Half invited to POC Saturday Drop-in Clinic
Half Posted letter and blood test form
IF numbers are maintained we expect 5% diagnostic rate, and 5% borderline rate
Phase 3 - Identification
30% predictive risk seems to = 14% current DM
15% predictive risk seems to = 5% current DM
Letter stating numerical risk seems to trigger response in some of them
E4H making significant impact
It is possible to screen surgery populations
It is possible to organize public event
Overall results
Raise awareness generally
Radio Berkshire
Newbury Weekly News and Chronicle
Health Service Journal
Pulse
Newbury Show
60,000 visitors
Aims of the PreDM Project
Lifestyle intervention for those at risk
E4H invitations
550 patients
100 attendees
Potentially 1/3 tonne weight loss!
Aims of the PreDM Project
Early identification of those at risk of, or already with DM2 without a diagnosis Phase 1 - Potentially 14 New DM
Phase 2 – 5 New DM
Phase 3 -Invitation for screening
One practice 266 patients
11 practices 1500 patients? Anticipated pickup rate of 5% in those responding
Possibly 30-70 new diagnoses
Aims of the PreDM Project
Public Health
Indicated they wish to repeat the Lifestyle intervention with E4H across NDCCG
NDCCG
Anticipate asking them to fund the detection arm of the project across the whole CCG population if Falkland Trial successful
The Future
Do you know how many patients have RBS > 11 or FBS > 7 or HbA1c > 47
Have all those patients with RBS > 7 had a recent follow up blood test
Have you reviewed the patients with IGT/IFG recently to see if they have been rechecked (20-50% 10yr conversion)
Challenges for you -Practices
EmisWEB
Activate popups that notify you of possible and probable DM
Consider installing QDiabetes Popup
Consider - Practices
Incentivize the Practices to do the above
Consider how you are responding to NICE Guidance
Identification of those with DM (offer screening for those at 15% risk)
Prevention of DM (targeted E4H lifestyle interventions)
Apply pressure to Software suppliers to integrate risk scoring software in INPS and SystmOne
Challenges - Commissioners
No proof of results (not enough power)
No long term data re weight loss etc.
Cost effectiveness
Need to define your terms!
Rural Berkshire 3.5% prevalence
Actual 5% ? (wide confidence margins)
Caveats
QInnovation – go for it
Surgery actions – resources online
CCG actions – “template” online
Not trying to produce research evidence of effectiveness but template for whether it is possible
Any Questions
www.predm.co.uk
Conclusions