Structured Education in the UK

What you are telling us….

Type 1 Education Network

Total programmes presented today

• 23 adult Type 1

• 4 paediatric

• 11 adult type 2

Type 1 programmes

• Patients per year 12 – 100

• Education per patient 5 – 40 hours

• Time period 5 days – 8 weeks

• Trained educators per centre 2 – 15

Length of Type 1 programmes

• 1 DAFNE national (68 centres) + 1 local (5 days)

• 16 run 1 day a week over 3 – 5 weeks

• 4 run 3 – 8 sessions over 3 – 8 weeks

• 1 is research project

Programmes• ADC (Advanced Diabetes Course) Redhill• ASPIRE (A Skills Programme in matching Insulin

Requirements to Eating and exercise) Chesterfield• BERTIE in Essex Chelmsford EDWARD (Education

for Diabetes Without Restricted Diet) Nottingham • BERTIE (Bournemouth Type 1 Intensive Education)• BRUCIE (Better Regulation Using Carbohydrate and

Insulin education) Ayr PDAC (Peterborough Dose Adjustment Course)

• CHARLIE ( Charing Cross and Hammersmith Advanced Resource for Living with Insulin and Eating)

Programmes• CHOICE (Carbohydrate and Insulin Calculation

Education) Windsor• DAFNE• DIANA ( Daily Insulin Adjustment to Nutrition

and Activities) Mile End, London Freedom 4 Life Bath

• Gift (Gateshead Insulin and Food training)• ICG (Intensive Control Group) Royal Free,

London• JIGSAW (Juggling Insulin for Goals Success And

Well-being) Portsmouth• NICER (Northern Ireland Carbohydrate

Educational Resource) Belfast

Programmes • PDAC ( Peterborough Dose Adjustment Course)• PRINCESS ( Princess Royal Insulin and

Carbohydrate Estimation Skills) Haywards Heath• REACCT (Re-Education and Carbohydrate

Counting Training) Gloucester• Skills for Life Bristol• TIEP (Type 1 Education Programme) Frimley Park)• TOPUP (Type One Diabetes Programme –

Understand and Progress) Newcastle• WINDFAL (Whittington Insulin Dosing for Active

Living)

Type 1 network programmes

Health professionals involved

• DSN’s• Specialist dietitians• Consultants• Clinical psychologist• Educational psychologist• Health informatics expert• Podiatrist

Meeting NICE Criteria

• Philosophy: 21 yes, 1 developing, 1 no (research project)

• Educational theories: 23 identified their theories (16 use social learning theory)

• Written curriculum: 21 yes, 2 no • Quality development: 13 yes, 3 in

development, 7 no• Audit: 20 yes, 3 no

Comments

• We have a type 1 education programme available to our patients that meet the NICE criteria

• Recognised by PCT as providing appropriate structured educational model for people living with type 1 diabetes

• Now able to offer structured education to large numbers of people with diabetes

Results

• 14 make direct quotes from participants and another 6 comment about improved QOL

• HbAIc reduction• Patients achieving their goals• Reduced insulin requirements• Improved awareness of hypoglycaemia• Reduced frequency of hypoglycaemia• Weight loss

Achievements

• Collaborating with sculptor to make work of art about experience of living with diabetes

• Many letters of support to chief executive who now wants to attend course

• Congratulated by PCT for contribution to healthcare commission

• Winning Arun Baksi Award• Influence of programme in decision to

build Healthy Living Centre

Common themes

• Information/support gained through T1EN• Attendance of partners• Community setting• Psychological input• Reference to other programmes e.g newly

diagnosed• Programme developed without additional

resources• Low drop out rate

Issues raised

• Intensive education a requirement before starting pump therapy (sometimes pump no longer needed)

• Follow up/reviews

• Shorter time frame versus some programmes have lengthened the time

Issues raised

• Educational process needs to be ongoing

• Programmes need to be updated• Change of concern from hypoglycaemia

to concerns about mood and living with diabetes

• Training other health professionals• Importance of consultant support

Ideas• Use of reflection diary with patients

• Insulin profile graphs/insulin ratio tables/insulin dose credit cards

• Supermarket tour

• Other health professionals attend course to gain understanding

Concerns

• Waiting list

• Lack of funding for programme and admin to collect data

Paediatric programmes

• Flexible Adjustment of Basal Bolus (FABB)

• Kids In Control Of Food (Kick-Off)

• FACTS

• Structured Education for Pumps (StEP)

FABB – Leicester Royal Infirmary

• 79 children/young adults from January 07• 5 hours education per course (2 x 2½

hours over 2 weeks)• 4 fully trained educators, all FABB aware• Positive feedback and reported

improvement of QOL• Rewarding for team despite steep learning

curve

Extra programmes

• Little FABB (under 5’s)• Extra FABB (special needs)• FABB for pumps• FABB for free mixing• PreFABB for MDI• FABB follow up

FACTS – Ipswich NHS Trust

• First programme September 03• 78 families have attended• 6 x 1½ hours education over 6 months• 12 trained educators• Refined FACTS 2 starting as RCT in

Norwich, Peterborough, Coventry, Nuneaton, Leicester, Dorset, Poole and Portsmouth

Proud of

• Programme could be beneficial if integrated into routine paediatric care

• Secured funding to develop both programmes and comprehensive evaluation

• Incorporates practical skills training with behavioural modification

• Results have been presented at DUK and published in Diabetes Care and diabetic Medicine

KICK-OFF

• Pilot recently completed, awaiting funding for RCT

• 2 age bands 11 – 13 and 14 – 16

• 32.5 hours education per course over 5 days

• 3 educators per course

Proud of

• Pilot study was well evaluated by children, friends and family

• Web-based programme being developed to support course

• Pilot study showed improved QOL but no change in HbAIc or BMI

• Won Diabetes UK education award in 2006

STeP – Leeds Teaching hospitals Trust

• Developed over last 5 years for children starting pump therapy

• 15 patients per year

• 6 – 12 hours either consecutive days or within 4 day period

• Web-based programme developed to compliment programme

Proud of

• Collaboration and support from a parent support group

• High level of satisfaction from children and families

• Each member of team involved• Clinical educator appointed to lead

further developments, quality assurance and audit

Type 2 programmes• 2 national programmes- Desmond and X-

PERT

• 4 local DESMOND

• 1 X-PERT adapted in Hindi or Punjabi

• 4 local programmes

• 1 pilot due to start January 2008

Type 2 programmes

• Patients per year 100 - 900

• Education per patient 6 - 14 hours

• Time period 1 day – 7 weeks

• Trained educators per centre 1 – 22

Meeting NICE Guidelines

• Philosophy: 10 • Educational theories: 10• Written curriculum: 10• Quality development: 10• Audit: 10• Research project starting in

January

DESMOND

• RCT – January 2004

• National roll out – January 2006

• Average 10 participants + partner per session

• 6 hours education delivered over 1 full day or 2 half days

67 PCT’s offer DESMOND

377 trained educators

673 attended RCT)

?10,000 attended so far

24 trainers and assessors

X-PERT• RCT 2001

• Implemented 2005

• 14 hours of structured education over 14 hours

• East Lancashire PCT have 18 educators

• Nationally 521 educators

1,539 attended since RCT

Results

• Mean participant evaluation score 93%• 17% (23%) increase in empowerment

score at 6 (12) monthsAt 6 months• 0.6% reduction in HbA1c• 3.1 Kg weight loss (3.9Kg at 12 months)• 2.5cm reduction in waist circumference

3 local DESMOND

• Peterborough

• Wakefield District and North Kirklees Diabetes Network

• East Surrey PCT and Surrey and Sussex NHS Trust

Aap Ki Sehat Aap Ke Haath• Hounslow NHS and West Middlesex

University Hospital, Isleworth

• Adapted from X-PERT

• 148 patients (July 06 to June 07)

• 5 sessions of 2 hours over 5 weeks

• 1 educator

Results (6 months)• Excellent attendance

• Decrease HbAIc 0.13%

• Decrease in BMI 0.14%

• Decrease 1.6%

• Good feedback

Bristol and South Gloucester PCT’s and North Bristol NHS

Trust• First course August 2005

• 800 patients per year

• 9½ hours education over 1½ days

• 22 trained educators (practice nurses, DSN’s, primary care dietitians, podiatrists, community pharmacist

Proud of

• Developing local staff in primary care to deliver programme

• Offering courses in a variety of locations• Robust QA process

• Developing ‘confidence to self-manage tool’

Dorset

• Poole Hospital NHS; Bournemouth and Poole PCT

• Both programmes have open-access within 1 week of diagnosis

• 500-900 patients per year

• Poole Hospital audit data shows mean HbAIc reduction of 2% in first 3 months

Whiston Hospital, Merseyside

• BENDS 2 pilot August 06, implemented January 07

• 780 patients first year• 12 hours education (3 hours over

weeks)• 14 trained educators

Proud of whole suite of education programmes that cater for needs of local population. Young, old, educated and uneducated engage and enjoy the programmes

Diabetes Education through Adult Learning (DEAL)

• Bend 1 – basic education for newly diagnosed type 1

• FETCH 1 – further education type 1

• FETCH 2 – further education for type 2

• ICE – insulin carbohydrate education

• FLEX – individual education for people with specific needs

Structured Education in the UK

What are you telling us?• We have made lots of progress since

NICE guidelines in 2003

• Many of you have put a lot of work and effort in

• Many achievements

Summary

We are proud to be changing tradition and making a difference to people’s lives

Summary of structured education in UK

• Some areas in UK still have very little structured education

• Some have started structured education but now need to make it part routine clinical care

• Some have incorporated programmes into routine care and looking at other areas

Challenges

• Funding

• Paediatric programmes

• BME programmes

• Record of programmes

Conclusion

Well done to everyone BUT we still have a long way to go before everyone with diabetes in UK has access to structured education