Diabetes - EMIS National User Group
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Transcript Diabetes - EMIS National User Group
Newbury and District CCG
Newbury Pre Diabetes Project
A real-world implementation of QDiabetes in a CCG Area
Tim Walter
What to expect from today
QInnovation
My Journey – where it started
Newbury Pre-Diabetes Project
Phase 1 Within Surgeries
Phase 2 County Show experience
Phase 3 Targetted screening?
As an example to copy/change as you wish
Resources www.predm.co.uk
QInnovation
Inaugural joint 2012-13 winners
Funded by QResearch ( in a joint partnership between
Emis, Emis NUG and University of Nottingham)
10k grant (on top of 18k from CCG)
Prof. Aziz Sheikh of Primary Care Research &
Development at the University of Edinburgh –
Smoking Cessation
Myself – Pre-Diabetes Project
Plus John Robson and Kambiz Boomla
My Journey
Jobbing GP
NUG – Arun Aggarwal
Diagnosis is Failure
QDiabetes
QInnovation
Liaison with Kambiz and John
Pre-Diabetes Project
Nice Guidance
Recent National Institute for Health and Clinical Excellence (NICE)
guidance has recommended:
•Identifying people at risk of developing type 2 diabetes, using a
validated risk assessment score and a blood test (fasting blood
glucose or HbA1c) to confirm high risk.
•Providing those at high risk with an intensive lifestyle-change
programme to prevent or delay the onset of type 2 diabetes.
Nice PH35
Preventing type 2 diabetes: population and community-level interventions
Recommendation 3 Developing a local strategy
Recommendation 6 Conveying messages to the local
population
Recommendation 8 Promoting a healthy diet: local
action
Recommendation 10 Promoting physical activity: local
action
Finnish Diabetes Prevention Study
reduce their weight by more than 5%
keep their fat intake below 30% of energy intake
keep their saturated-fat intake below 10% of energy
intake
eat 15 g/1000 kcal of fibre or more
are physically active for at least 4 hours per week.
Components of the project
QDiabetes Tool
Targeted screening
Concept of Pre-Diabetes
Early intervention reduces risk by up to 70%
Lifestyle interventions (E4H) work in the short term
Project looks to combine these to assess practical
issues and costs
Newbury PreDM Project
113,000 - mixed clinical system CCG
Surgery Process, 1st cohort EmisWEB
Instructions to practices to run the bulk QDiabetes
module
Identify patients with > 30% 10yr risk
Invitation to have bloods and join E4H Group
Currently ending 2nd Cohort phase, LV and INPS
Surgery Phase – 1st Cohort Results
50 patients invited per practice (5 surgeries) (30-80% risk
calculations)
250 in first cohort
18% uptake
Of those having bloods 14% at diagnostic levels, more with
marginal results
E4H – Average 3kg Weight loss, = 110Kg total
Up to 15Kg loss
1kg =16% risk reduction in DM
Surgery Phase - Costs per practice
Admin charge 150
E4H staff cost 400
Accommodation 400
Total cost therefore 1000 per practice
Approx benefit – 1DM, average 3kg weight loss per
participant, raising profile etc
Newbury Show
60,000 attendees
21-22nd September
2 clinicians doing QDiabetes Screening
2 PH Nurses doing HbA1c for those with high scores
3 E4H staff giving advice, BCA and enrolling to E4H
Sessions
Newbury Show Stand
Newbury Show PreDiabetes Stand
During a quiet spell!
Newbury Show - Results
Potential Audience of 60,000
310 Screened via QDiabetes on iPads
111 targeted HbA1c tests done
80 Body Fat/Composition Measurements
30 people signed up for E4H classes
5 New diabetics (up to HbA1c = 64)
NB Health Promotion vs Detection
Is it financially worthwhile
Breast screening
2 million women
15000 diagnoses
96 million pounds
50 pounds per screen
6000 pounds per diagnosis
Is it financially worthwhile
Cervical cancer
5 million invites
3.5 million tests
200,000 abnormals
4000 cancers prevented
175 million pounds
About 1000 pounds per abnormal, and about 40,000
pounds per cancer prevented
Is it financially worthwhile ???
Diabetes – Newbury Show
60,000 attendees
310 screened with QDiabetes
111 HbA1c tests
5 New Diabetics
Cost per diagnosis 1000 pounds
What can you do?
QDiabetes bulk calculation
QDiabetes Template
QDiabetes pop-up alert
Resources at www.predm.co.uk
Demo
Caveats
No proof of results (not enough power)
No long term data re weight loss etc.
Cost effectiveness
Need to define your terms!
Rural Berkshire 3.5% prevalence
Actual 5% ? (wide confidence margins)
Overall results
30% predictive risk seems to = 10% current DM
Letter stating numerical risk seems to trigger
response in some of them
E4H making significant impact
It is possible to screen surgery populations
It is possible to organise public event
Conclusions
QInnovation – go for it
Surgery actions – resources online
CCG actions – “template” online
Not trying to produce research evidence of
effectiveness but template for whether it is possible
Any Questions
www.predm.co.uk