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A quiet revolution in diabetes care

Amy Rylance, Head of Healthcare Professional Engagement at Diabetes UK

In amongst the lurid daily headlines about the crisis in the NHS and the ticking time-bomb of diabetes, good news can be hard to find. But a quiet revolution in diabetes care is taking place and over 82,000 clinical consultations have been transformed so far.

Working with healthcare professionals, I hear a lot about the devastating and life-threatening complications of diabetes, including heart disease, amputations and strokes. These complications cost the NHS £8bn a year. Finding an effective way to engage patients and prevent these complications from ever happening is the holy grail of improving health, transforming people’s quality of life and saving the NHS money.

Despite this, day after day Diabetes UK’s helpline receives calls from people who have left their GP surgery confused and scared about how to manage their diabetes. This is not surprising: one study showed that only 14 per cent of the information was remembered correctly when people received spoken medical instructions, compared with over 80 per cent when pictographs were used.[i] Talking to clinicians and people living with diabetes it became clear both were hugely frustrated by the challenges of managing this complex condition in extremely time pressured consultations.

The solution came from a series of workshops with clinicians, people with diabetes and health academics to develop a tool that could make consultations work better for all. A set of bespoke information prescriptions were developed to transform the standard diabetes consultation. The clinically accurate resources are designed help healthcare professionals and people with diabetes to make decisions together about the treatment and self-management of their diabetes. The patient gets a personalised single side of A4 to take away with them which includes easy-to-read explanations, clear images and individual goals.

The information prescriptions are embedded in clinical IT systems, which means that they are quick to use, fundamental if they are to get traction in the pressured NHS. Clinicians receive electronic alerts prompting them to intervene with patients who are at higher risk of devastating complications. Clinicians say that this is changing their behaviour, prompting them to intervene more proactively and highlighting patients who have slipped through the net for years. Data from clinical system EMIS Web shows that use of information prescriptions is rising steadily and they have now been used in over 82,000 clinical consultations.

But getting traction with clinicians is only half the story; information prescriptions are also showing that they can tackle the fear and confusion that leaves people vulnerable to complications. Many patients say that the information prescription was the first time anyone had explained the condition to them. Nicola Milne, a practice nurse using information prescriptions in Manchester, says that “individuals report a clearer understanding of the concepts and relevance of HbA1c, lipids and blood pressure and an enhanced motivation to adopt lifestyle modification specific to their own needs.”

And that increased understanding is making a difference to people’s health. An audit of one GP practice in Glasgow showed a ten per cent increase in the proportion of patients reaching their blood glucose targets in the year after the information prescriptions were introduced. More patients hitting targets means less patients at risk of amputations, blindness and all the other horrid complications of diabetes.

General Practitioner Dr Stephen Lawrence explains, “information prescriptions put patients in the driving seat and that is the key to driving successful behavior change. Having piloted it I know that it works and the feedback I’ve had from patients is that they feel more in control and like having clear goals set out to help them improve their health. This is a revolutionary step in diabetes care.”

In response to demand from clinicians and people with diabetes, Diabetes UK are launching new information prescriptions focusing on some of the topics in diabetes management that create real challenges: kidney disease, safe pregnancy and psychological wellbeing.

To join the revolution go towww.diabetes.org.uk/info-p-qa.

[i] Kessels RPC. Patients’ memory for medical information. Journal of the Royal Society of Medicine. 2003;96(5):219-222.

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