Dr Pete Davies; p.davies@nhs.net 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

Engaged empowered patient Organised proactive system All eggs in one basket? Lots of focus, attention and investment “Cinderella” Engaged empowered patient Organised proactive system Partnership = Better outcomes Service redesign; QoF, etc. e.g. Diabetes education course ever offered: 2006- 11%; 2009- 13%

Self-care 3 % = 0.03 % 8,760 The average person with diabetes will spend three hours a year with a professional and the remaining 8,757 hours caring for themselves. 3 8,760 = % 0.03 %

Care Planning Usual care Future care planning 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 p.davies@nhs.net International Diabetes Federation & WHO