Personalised SMS Care Plan for Diabetes
by West Green Surgery
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West Green Surgery wanted to improve the identification and management of diabetes and hypertension in its patients. In November 2017, it had a National Diabetes Audit achievement of 37% and 28% of patients had poorly-controlled hypertension. Software was developed that recalled patients more efficiently while educating them about their results. It analysed the disease registers and sent personalised messages to patients informing them of their health values, urging medication compliance, providing links to health information or directing them to make an appointment. Patients have become more empowered with their health data and more actively engaged in their health management.
"West Green Surgery have demonstrated a very impressive project which brought together a multidisciplinary team with patients. This programme took the familiar SMS notification concept and turned it into a highly innovative and impactful service, resulting in significantly lower levels of DNAs, as well as improvements in Hba1c and blood pressure. The fact that the software is shareable, scalable and flexible makes this an excellent candidate for national uptake, with evidence of its cost effectiveness beyond question."
Diabetes Technology Network UK
by Association of British Clinical Diabetologists
The Diabetes Technology Network UK (DTN-UK) launched in 2016. Led by Dr Emma Wilmot, the team has delivered initiatives to improve access to diabetes technology, 11 educational meetings (2016-19), three national clinical best practice guides, three online webinars (953 registrations, >1500 views) and 13 online modules for people living with diabetes and their health care professionals. DTN-UK has over 500 members and 1,384 followers on Twitter. It campaigned for better access to flash glucose monitoring, developed the FreeStyle Libre national audit, the 2018 national Type 1 diabetes service level audit and helped to develop the NHSE/Diabetes UK technology pathway.
"Diabetes Technology Network UK is a well-established initiative to increase access to diabetes technology, and has an impressive track record of success since its inception three years ago. This latest work adds to its numerous achievements in HCP education, upskilling and providing national leadership on technology issues. Particularly notable is its lead on promoting uptake of flash glucose monitoring and conducting a national audit on insulin pump access."
AT Medics and AT Learning Diabetes Improvement Programme 2018/19
by AT Medics and AT Learning
AT Medics manages over 30 GP surgeries with 275,000 patients across London. In 2018/19 the organisation continued its ‘Diabetes Improvement Programme’, using a quality improvement approach to reduce variation in the management of its diabetic population (>13,000 patients), as defined by the National Diabetes Audit (NDA) eight care processes and three treatment targets. This resulted in it having the highest-ever outcomes for Type 2 diabetes care in England and Wales compared to any Clinical Commissioning Group (CCG) (NDA data). AT Medics’ approach now covers an entire London CCG, supporting capability development and an associated major improvement in diabetes outcomes.
"An impressive project aimed at reducing diabetes service variation at scale. This produced some robust effectiveness data and strong user feedback, with lots of scope for bringing safety monitoring up to this same standard in particular, along with cost effectiveness metrics."