Structured Education in the UK What you are telling us….

Type 1 Education Network

Total programmes presented today

• 23 adult Type 1 • 4 paediatric • 11 adult type 2

Type 1 programmes

• Patients per year 12 – 100 • Education per patient 5 – 40 hours • Time period 5 days – 8 weeks • Trained educators per centre 2 – 15

Length of Type 1 programmes

• 1 DAFNE national (68 centres) + 1 local (5 days) • 16 run 1 day a week over 3 – 5 weeks • 4 run 3 – 8 sessions over 3 – 8 weeks • 1 is research project

Programmes

• ADC (Advanced Diabetes Course) Redhill • ASPIRE (A Skills Programme in matching Insulin Requirements to Eating and exercise) Chesterfield • BERTIE in Essex Chelmsford EDWARD (Education for Diabetes Without Restricted Diet) Nottingham • BERTIE (Bournemouth Type 1 Intensive Education) • BRUCIE (Better Regulation Using Carbohydrate and Insulin education) Ayr PDAC (Peterborough Dose Adjustment Course) • CHARLIE Eating) ( Charing Cross and Hammersmith Advanced Resource for Living with Insulin and

Programmes

• CHOICE (Carbohydrate and Insulin Calculation • DAFNE • DIANA ( Daily Insulin Adjustment to Nutrition Bath • Gift (Gateshead Insulin and Food training) • ICG (Intensive Control Group) Royal Free, London • JIGSAW (Juggling Insulin for Goals Success And Well-being) Portsmouth • NICER (Northern Ireland Carbohydrate Educational Resource) Belfast

Programmes

• PDAC ( Peterborough Dose Adjustment Course) • PRINCESS ( Princess Royal Insulin and Carbohydrate Estimation Skills) Haywards Heath • REACCT (Re-Education and Carbohydrate Counting Training) Gloucester • Skills for Life Bristol • TIEP (Type 1 Education Programme) Frimley Park) • TOPUP (Type One Diabetes Programme – Understand and Progress) Newcastle • WINDFAL (Whittington Insulin Dosing for Active Living)

Type 1 network programmes

Health professionals involved

• DSN’s • Specialist dietitians • Consultants • Clinical psychologist • Educational psychologist • Health informatics expert • Podiatrist

Meeting NICE Criteria

• Philosophy: 21 yes, 1 developing, 1 no (research project) • Educational theories: • Written curriculum: • Quality development: 23 identified their theories (16 use social learning theory) 21 yes, 2 no 13 yes, 3 in development, 7 no • Audit: 20 yes, 3 no

Comments

• Recognised by PCT as providing appropriate living with type 1 diabetes

Results

• 14 make direct quotes from participants and another 6 comment about improved QOL • HbAIc reduction • Patients achieving their goals • Reduced insulin requirements • Improved awareness of hypoglycaemia • Reduced frequency of hypoglycaemia • Weight loss

Achievements

• Collaborating with sculptor to make work of art about experience of living with diabetes • Many letters of support to chief executive who now wants to attend course • Congratulated by PCT for contribution to healthcare commission • Winning Arun Baksi Award • Influence of programme in decision to build Healthy Living Centre

Common themes

• Information/support gained through T1EN • Attendance of partners • Community setting • Psychological input • Reference to other programmes e.g newly diagnosed • Programme developed without additional resources • Low drop out rate

Issues raised

• Intensive education a requirement before starting pump therapy (sometimes pump no longer needed) • Follow up/reviews • Shorter time frame versus some programmes have lengthened the time

Issues raised

• Educational process needs to be ongoing • Programmes need to be updated • Change of concern from hypoglycaemia to concerns about mood and living with diabetes • Training other health professionals • Importance of consultant support

Ideas

• Use of reflection diary with patients • Insulin profile graphs/insulin ratio tables/insulin dose credit cards • Supermarket tour • Other health professionals attend course to gain understanding

Concerns

• Waiting list • Lack of funding for programme and admin to collect data

Paediatric programmes

• Flexible Adjustment of Basal Bolus (FABB) • Kids In Control Of Food (Kick-Off) • FACTS • Structured Education for Pumps (StEP)

FABB – Leicester Royal Infirmary

• 79 children/young adults from January 07 • 5 hours education per course (2 x 2½ hours over 2 weeks) • 4 fully trained educators, all FABB aware • Positive feedback and reported improvement of QOL • Rewarding for team despite steep learning curve

Extra programmes

• Little FABB (under 5’s) • Extra FABB (special needs) • FABB for pumps • FABB for free mixing • PreFABB for MDI • FABB follow up

FACTS – Ipswich NHS Trust

• First programme September 03 • 78 families have attended • 6 x 1½ hours education over 6 months • 12 trained educators • Refined FACTS 2 starting as RCT in Norwich, Peterborough, Coventry, Nuneaton, Leicester, Dorset, Poole and Portsmouth

Proud of

• Programme could be beneficial if integrated into routine paediatric care • Secured funding to develop both programmes and comprehensive evaluation • Incorporates practical skills training with behavioural modification • Results have been presented at DUK and published in Diabetes Care and diabetic Medicine

KICK-OFF

• Pilot recently completed, awaiting funding for RCT • 2 age bands 11 – 13 and 14 – 16 • 32.5 hours education per course over 5 days • 3 educators per course

Proud of

• Pilot study was well evaluated by children, friends and family • Web-based programme being developed to support course • Pilot study showed improved QOL but no change in HbAIc or BMI • Won Diabetes UK education award in 2006

STeP – Leeds Teaching hospitals Trust

• Developed over last 5 years for children starting pump therapy • 15 patients per year • 6 – 12 hours either consecutive days or within 4 day period • Web-based programme developed to compliment programme

Proud of

• Collaboration and support from a parent support group • High level of satisfaction from children and families • Each member of team involved • Clinical educator appointed to lead further developments, quality assurance and audit

Type 2 programmes

• 2 national programmes- Desmond and X-PERT • 4 local DESMOND • 1 X-PERT adapted in Hindi or Punjabi • 4 local programmes • 1 pilot due to start January 2008

Type 2 programmes

• Patients per year 100 - 900 • Education per patient 6 - 14 hours • Time period 1 day – 7 weeks • Trained educators per centre 1 – 22

Meeting NICE Guidelines

• Philosophy: 10 • Educational theories: 10 • Written curriculum: 10 • Quality development: 10 • Audit: 10 • Research project starting in January

DESMOND

• RCT – January 2004 • National roll out – January 2006 • Average 10 participants + partner per session • 6 hours education delivered over 1 full day or 2 half days

67 PCT’s offer DESMOND 673 attended RCT) ?10,000 attended so far 377 trained educators 24 trainers and assessors

X-PERT

• RCT 2001 • Implemented 2005 • 14 hours of structured education over 14 hours • East Lancashire PCT have 18 educators • Nationally 521 educators

1,539 attended since RCT

Results

• Mean participant evaluation score 93% • 17% (23%) increase in empowerment score at 6 (12) months At 6 months • 0.6% reduction in HbA1c • 3.1 Kg weight loss (3.9Kg at 12 months) • 2.5cm reduction in waist circumference

3 local DESMOND

• Peterborough • Wakefield District and North Kirklees Diabetes Network • East Surrey PCT and Surrey and Sussex NHS Trust

Aap Ki Sehat Aap Ke Haath

• Hounslow NHS and West Middlesex University Hospital, Isleworth • Adapted from X-PERT • 148 patients (July 06 to June 07) • 5 sessions of 2 hours over 5 weeks • 1 educator

Results (6 months)

• Excellent attendance • Decrease HbAIc 0.13% • Decrease in BMI 0.14% • Decrease 1.6% • Good feedback

Bristol and South Gloucester PCT’s and North Bristol NHS Trust

• First course August 2005 • 800 patients per year • 9½ hours education over 1½ days • 22 trained educators (practice nurses, DSN’s, primary care dietitians, podiatrists, community pharmacist

Proud of

• Developing local staff in primary care to deliver programme • Offering courses in a variety of locations • Robust QA process • Developing ‘confidence to self-manage tool’

Dorset

• Poole Hospital NHS; Bournemouth and Poole PCT • Both programmes have open-access within 1 week of diagnosis • 500-900 patients per year • Poole Hospital audit data shows mean HbAIc reduction of 2% in first 3 months

Whiston Hospital, Merseyside

• BENDS 2 pilot August 06, implemented • 780 patients first year • 12 hours education (3 hours over weeks) • 14 trained educators Proud of whole suite of education programmes that cater for needs of local programmes

Diabetes Education through Adult Learning (DEAL)

• FETCH 1 – further education type 1 • FETCH 2 – further education for type 2 • ICE – insulin carbohydrate education • FLEX – individual education for people with specific needs

Structured Education in the UK What are you telling us?

• We have made lots of progress since NICE guidelines in 2003 • Many of you have put a lot of work and effort in • Many achievements

Summary

We are proud to be changing tradition and making a difference to people’s lives

Summary of structured education in UK

• Some areas in UK still have very little structured education • Some have started structured education but now need to make it part routine clinical care • Some have incorporated programmes into routine care and looking at other areas

Challenges

• Funding • Paediatric programmes • BME programmes • Record of programmes

Conclusion

Well done to everyone structured education BUT we still have a long way to go before everyone with diabetes in UK has access to