Barnsley X-pert Education Programme - PowerPoint Presentation

1. Barnsley X-pert Education ProgrammeJennifer Thawley, Specialist Diabetes Dietitian, Jennifer.thawley@nhs.net, Tel: 01226 438817Leander Parkinson, Diabetes Specialist Nurse, leander.parkinson@nhs.net, Tel: 01226 645180

2. Obesity is the largest risk factor for Type 2 Diabetes accounting for 80-85% of overall risk61% of adults and 30% of children in the UK are overweight or obeseNumber of people with Type 2 Diabetes has doubled since 199680% of people with Type 2 Diabetes will die of CVDOn average life expectancy is reduced by up to 7 years for those with Type 2 DiabetesThese figures are set to double by 2030Collectively Obesity and Diabetes costs the NHS - £16 billion/ year. Costing UK economy £47 billion / year as a result of ill-health and inability to workFACTS & STATS Diabetes UK, October 2016The Stats

3. Barnsley CCG spent a total of £4.5 million on prescriptions for diabetes items between April 2015 and March 2016. This was equivalent to £290.24 per adult with the condition, £8.72 higher than the England average spends of £281.52People with diabetes in Barnsley were 46.4% more likely to have a myocardial infarction, 33.8% more likely to have a stroke, 75.3% more likely to have a hospital admission related to heart failure and 38.3% more likely to die than those without diabetes in the same areaLocal Stats

4. Proven to effectively delay the onset of Type 2 Diabetes, achieve treatment goals for immediate risk factors (weight management, BP, HbA1c, CVD Risk) and therefore prevent complications (DUK, 2016).A SR of 21 RCTs- Group Ed significantly improves key markers: HbA1c, knowledge and self-management skills as well as weight at 12 months (Steinbekk et al, 2012) Cost effective and is associated with fewer visits to the GP and use of other health services (DUK, 2016)It is essential to equip patients with the knowledge and confidence they need to manage this complicated condition on a day to day basis given that they will only get the opportunity to see a medical professional for an average of 3 hours a year (Roberts, 2007)Best practice to offer structured education to adults with Type 2 Diabetes and/or their family members or carers (as appropriate) at and around the time of diagnosis, with annual reinforcement and review. It is vital to explain to people and their carers that structured education is an integral part of diabetes care (NICE, 2015). Nutrition and lifestyle education programmes form a fundamental part of care

5. The X-pert Diabetes Programme is provided FREE via the NHS for anyone with Type 2 Diabetes (Diet alone/ Diet and Oral Hyperglycaemics and/or Insulin treated)The X-PERT Diabetes programme is evidence based and proven to increase your patients knowledge, skills and understanding of their condition and help them to make lifestyle choices to manage their own blood glucose levels more effectively. See overview of curriculum - hand outIt is nationally accredited and delivered by trained staff- Specialist Dietitian, Dietetic Assistant and Specialist NurseSo what is X-pert?

6. Data provided by the Yorkshire and Humber Specialist Clinical Network reported 398 referrals to structured group education, of which only 175 patients attended one or more sessions. Why is attendance so poor in Barnsley?Outcomes Framework (QOF) incentivises the recording of referrals into structured education (QOF ID DM014) there is no incentive within QOF to record attendance in structured education programmes (YHSCN, 2015). Attendance to group education in Barnsley CCG

7. The evidence suggests that healthcare professionals do not explain in clear, motivating language the benefits of attending education programmes (Lawal, 2014). Lack of understanding may result in not referring or promoting the benefits of attending (Dale et al, 2014; Diabetes UK, 2014; Lawal, 2014; Winkley et al, 2014).From a patients point of view there is the stigma and shame of diabetes (Winkley et al, 2014), a low perception of the seriousness of diabetes, and the individual’s belief that they already have the knowledge (Lawal, 2014). Group education for many is intimidating. It can conjure up “negative feelings” and remind people of school or a previous insensitive interaction with a healthcare professional (Diabetes UK, 2014; Lawal, 2014).There is also practical issues such as locality, timing and frequencyPoor Attendance

8. Have the confidence to articulate what diabetes education can offer and dispel the negative connotations that surround the word “education”.Be Positive and Enthusiastic about the benefits. Be clear that attending an education course is such a positive thing for the patient. It is part of care.Accept that some individuals might feel that 2.5hrs once a week for 6 weeks is a long time, or may say that they do not wish to take the time off work. Negotiate the positive outcomes of attending- reduced sickness and risk of complications over a life timeRecognise that although an individual may not be ready to change at diagnosis they may well have changed their mind following a diabetes related complication or hospital admission- it is important to regularly promote education at any opportunityYour positivity is key to turning referrals in to attendance!Turning referrals in to attendance

9. Once a referral is agreed you simply need to make a referral to group education via the Diabetes Single Point of Access (SPA).It is important to let the patient know that they will be given a date and time to contact the service to pick which course they wish to attend.Give the patient an X-PERT LeafletThe patient will need a copy of key biochemistryHow do I refer?

10. We deliver courses over a range of times including morning, afternoon and evenings, on various days Monday to Friday.The Roundhouse Medical Centre, Wakefield Rd, Athersley, S71 1THApollo Court Medical Centre, High Street, Dodworth, S75 3RF Walderslade Surgery, High Croft. Hoyland, S74 9AFThe Thurnscoe Centre, Holly Bush Drive, Thurnscoe, S63 0LTOaks Park Primary Care Centre, Thornton Road, Kendray, S70 3NE When & Where?

11. Please don’t hesitate to contact the team regarding any aspect of diabetes and diet or education in future (contact details on the first slide).If you would like a copy of todays power point please email me.Any Questions?

12. Steinsbekk, A., Rygg, L., Lisulo, M., Rise, M.B. and Fretheim, A. (2012) ‘Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis’, BMC Health Services Research, 12(1), p. 213. doi: 10.1186/1472-6963-12-213.Diabetes UK (2016) Diabetes education: The big missed opportunity in diabetes care. Available at: https://www.diabetes.org.uk/Upload/Get%20involved/campaigning/Taking%20Control/Diabetes%20UK_Diabetes%20education%20-%20the%20big%20missed%20opportunity_updated%20June%202016.pdf (Accessed: 4 November 2016).Lawal, M. (2014) Barriers to attendance in diabetes education: A systematic review. Diabetes & Primary Care, 16 (6): 299-306NICE (2015) Type 2 Diabetes in Adults: Management. Available at: https://www.nice.org.uk/guidance/ng28?unlid=739233160201610316820 (Accessed: 30 October 2016).Winkley, K., Evwierhoma, C., Amiel, S.A., Lempp, H.K., Ismail, K. and Forbes, A. (2014) ‘Patient explanations for non-attendance at structured diabetes education sessions for newly diagnosed type 2 diabetes: A qualitative study’, Diabetic Medicine, 32(1), pp. 120–128. doi: 10.1111/dme.12556.References