1. Dr Pete Davies; p.davies@nhs.net
Facilitating diabetes consultations through sharing blood test information- “Delivering results to you”
Dr Pete Davies;

2. Facilitating Diabetes Consultations: Share Information. Empower people.

3. 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

4. How to get Better Outcomes in LTC
Engaged empowered patient
Organised proactive system
Partnership
= Better outcomes

5. 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:
%; %

6. 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 %

7. 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

8. 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!

10. 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

11. Health Literacy Dimensions
Patient group consultation
Convey levels with colour ruler or traffic lights
Good control links to green, healthy plant/tree

12. 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

13. Professional Help One member of patient group was a graphic designer!
Artwork ideas discussed with 2 independent graphic designers

14. 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 or 11 year old, respectively
Not bad for an abstract concept 

16. 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’

17. 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

18. 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

19. Acknowledgements

20. Understand diabetes. Take control
International Diabetes Federation & WHO