Cardiometabolic Care: A Pharmacist Run Diabetes Clinic in General Practice
by The Paula Carr Diabetes Charitable Trust
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Figures suggested that patients with diabetes in the Medway Clinical Commissioning Group area were 88.6% more likely to have a heart attack and 85.7% more likely to have a stroke than the general population. Also, targets for blood pressure and cholesterol were below the NHS England average. These findings prompted a service re-evaluation. Glycaemic support is inadequate to manage macrovascular complications, but a multifactorial management approach can reduce cardiovascular mortality by about 50%. A pharmacist prescriber ran a pilot service for eight months, using a cardiometabolic approach to review glycaemic control, blood pressure and chronic kidney disease in five practices.
"The transformation achieved in this submission is almost unparalleled – it is a great example of the benefit that pharmacists can have in diabetes care. This is a fantastic idea that deserves to be championed, and a model that needs to be replicated elsewhere. The cost was small, but the difference made to patient care was enormous. A deserving winner!"
WISDOM: West Hants Improving Shared Diabetes Outcome Measures. A Blueprint
by West Hants Community Diabetes Service
WISDOM (West Hampshire Improving Shared Diabetes Outcome Measures) was developed in September 2017 in response to below average CCG NDA outcomes for the three treatment targets for type 2 diabetes. The project evolved from a blueprint for Primary Care Network (PCN) management of diabetes to a sustainable component of the new community service contract (April 2020). It focuses on professional culture change, rapid clinical results and wider adoption across the locality. It illustrates how a large, population-level intervention can deliver measurable results within two years, change existing commissioned activity and influence neighbouring Dorset and Southampton CCGs to adopt it.
"A remarkable project – this is a true innovation in the diabetes healthcare setting. The initiative demonstrated an effective use of resources, with good outcomes across many practices. The judges particularly liked the proactive approach and felt that the project’s far-reaching benefit was a massive achievement for all involved."
Norwich Inpatient Diabetes Service (NIPDS): Supporting Staff, Empowering Patients, Preventing Glycaemic Harms
by Norfolk & Norwich University Hospital NHS Foundation Trust
A multidisciplinary inpatient diabetes service (IPDS) model was developed to improve inpatient diabetes care. This comprised a succession of interventions in service delivery, systemic changes and staffing levels, implemented over 18 months. The aim was to amplify outcomes via the augmentative effects of each single intervention. Outcome data demonstrated significant success in supporting staff, protecting at-risk patient groups, empowering patients via education and preventing glycaemic harms. The qualitive improvement outcome, cost-effectiveness and sustainability were acknowledged by significant additional funding to expand the IPDS team. Data from this work supported the recent JBDS-IP national guideline on Diabetes Inpatient Specialist Nurses (DISN).
"The cumulation of efforts in this submission made a real difference to patient outcomes in inpatient diabetes. This initiative demonstrated long-term, sustainable practice in a particularly important area of diabetes care. The clinicians involved highlighted the issue and continued to address it over the years. A very sustainable entry!"
Developing a Community ‘Walk in’ Clinic for Diabetic Foot Disease
by Community / Cardiff and Vale UHB
Approximately 1% of the NHS budget is spent on active foot disease in diabetes. As up to 80% of these foot problems are largely preventable (Kerr et al, 2019) this is economically unviable and unsustainable, as well unacceptable for patients and healthcare professionals. Early intervention is the answer. The ‘walk-in’ clinic allows access to a member of the multidisciplinary foot team (MDFT) when care is needed, ensuring timely, effective care. Providing opportunities to support care closer to home, without the need for a primary care referral, enables patients to access the most appropriate service at times of crisis.
"This was a simple but effective project that has the potential to be quickly implemented widely across diabetes care. Those involved in this initiative adopted a ‘just do it’ attitude that targeted a specific sub-population, which was a fantastic idea. This project put patients at the centre of its approach and looked at the individual needs of each and every person involved."
The Diabetes Care in Elderly, Frail, ENd-of-Life and Dementia(DEFEND) Project
by London Northwest University Healthcare NHS Trust
Project DEFEND was established to improve the quality of diabetes care and safety in Brent’s frail adult community. It aligns local pathways and resources to create a data-driven collaborative care model.The databases of five GP practices highlighted that, out of 1,000 patients with frailty, 695 had an HbA1c lower than 58 mmol/mol. Of these, 100 patient records were reviewed in a virtual clinic with primary care clinicians and grouped into high, medium or low risk of diabetes emergencies. More than 40% were in the medium or high-risk group, over 60% needed a medication change and nearly 20% needed referral to supported care.
"This submission clearly outlined its goals and set out what they wanted to achieve, in an important area of diabetes care. It both targeted a vulnerable population and improved outcomes, and clearly communicated a message that needs to be widely disseminated and praised."