After being awarded ‘highly commended’ at QiC in 2019, the diabetes training programme for clinical pharmacists, COMPLEMENT (COMPLEte MENToring for clinical pharmacists) was rolled out across Leicester and Leicestershire. The COVID-19 pandemic meant the programme had to be adapted quickly into COMPLEMENT PLUS – an easily accessible, fully virtual, diabetes training programme for clinical pharmacists, relevant to all during a pandemic. Updating of the programme began in March 2020 and the first cohort took the course in June 2020. It consists of four pre-recorded lessons, four e-learning modules and four virtual mentoring sessions, and has replaced the original COMPLEMENT programme.
The COMPLEMENT programme proved that clinical pharmacists, given the required training, could effectively care for people living with diabetes. A more sustainable training programme was needed to support and utilise pharmacists to help all people living with diabetes during a pandemic. The increasing incidence of diabetes, and associated increase in morbidity and mortality, also had to be addressed. COVID-19 also seemed to target those with diabetes, comorbidities and obesity and was more prevalent in people from minority ethnicities and/or areas of deprivation. Pharmacists needed training to minimise risk in these patients. The new diabetes training solution was COMPLEMENT PLUS, developed in consultation with 100 clinical pharmacists working in Leicester. The modules were aligned to the UKPCA competency framework for Diabetes. A ‘knowledge and confidence’ questionnaire was used to highlight training needs and subsequently to measure the programme’s success. Pharmacists felt isolated and needed support and reassurance, so the training contained a supportive mentoring element. The blended learning approaches catered for all learning styles. The recorded lessons were both visual and audible. The e-learning modules were interactive, incorporating quizzes and challenges with a post-course test. The mentoring sessions provided time for peer reflection, experience sharing, questions and discussion.
Equality, Diversity and Variation
Leicester is culturally diverse, with 340,000 people who speak more than 70 different languages and dialects. Its diabetes prevalence is among the highest in the UK at 8.9%. Work with the Centre for Ethnic Health Research, based at the diabetes centre, aims to reduce variations in care and reduce adverse diabetes-related health outcomes. A total of 35 pharmacists were trained under the COMPLEMENT PLUS programme over the year. Of these, four were of African-Caribbean descent, 17 were South Asian, six were Eastern European and eight were white British. Half were male and half were female. The cultural diversity was a real advantage during the group mentoring sessions. Challenges regarding language when communicating with patients in clinic, signposting where to access information for patients in other languages, and how to use the interpreting systems were addressed. The virtual platform enabled wider access to pharmacists. Mentoring discussions covered the challenges of working in more deprived areas, how to reach ethnic minority communities and training faith leaders or employers to become ‘health advocates’.
Pre-programme and post-programme ‘knowledge and confidence’ questionnaire data were collected to demonstrate quality and efficiency. Delegates rated themselves on 25 topics using a 1-5 confidence scale. There was a 40-60% improvement in knowledge and confidence comparing before and after scores. Patient data proved that the benefits were passed directly to people living with diabetes, with average HbA1c % change reduction of 18.2%; average cholesterol % change reduction of 12.9%; average systolic BP % change reduction of 5.9%, and average diastolic BP % change reduction of 7.1%. Qualitative feedback, from patients seen by the trained pharmacists, found 97% were very satisfied; 3% were satisfied; 100% said they were confident in the pharmacist’s ability and 100% would see the pharmacist again. Well trained pharmacists can help reduce health costs. These issues are covered in the training: blood glucose meters; prescribing meters from formulary with correct test strips/amounts; use of biosimilar insulins; concordance – how to find out if patients are taking their medication, encouraging medication adherence; simplifying and withdrawing treatment when appropriate prevents falls, hypoglycaemia, hospital admissions; reducing medication requirements by encouraging lifestyle change and weight loss; injection technique – preventing lipohypertrophy can reduce insulin requirements. All of these result in cost savings and better quality of life for patients.
Dissemination and Sustainability
The original COMPLEMENT programme was run locally with funding from Leicester City CCG but there was wider demand across the country. The pandemic accelerated the need for, and development of, a new programme. Trained pharmacists have the information to enable them to give reliable advice to their concerned patients. Now, emphasis during mentoring is more focused on helping patients get ‘back on track’ and on how to discuss and encourage lifestyle behaviour changes. The benefit of live group mentoring sessions is that current topics can be discussed. The content of the lessons and e-learning are up to date and relevant but are designed to be easily updated. This initiative and model could be implemented for any sector. Group mentoring consolidates learning and embeds it into practice.
Novo Nordisk funded 20 places; two cohorts were run nationally. Leicester and Leicestershire CCGs also commissioned the programme. The head of the CCG stated: “Our pharmacists are now able to effectively manage patients with multi-morbidities and not just focus on their HbA1c control. Patients have been cared for in a holistic manner, empowering them to take control of their own wellbeing alongside the nine care processes. Having a pharmacist on board has allowed the practice to manage diabetes from a proactive approach and consider preventing complications and not just treatment. Our pharmacists have made significant interventions to support patients improve their understanding of their condition and alter their lifestyles to improve their long term prognosis.” Delegates said that they found the flexibility of the programme a major advantage and said the mentoring groups were a success. With training, pharmacists have the potential to meet complex needs and reduce workload pressures in primary care. The model is cost effective and sustainable. COMPLEMENT PLUS is being developed for practice nurses.
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