Implementing an active foot disease pathway for people with diabetes in South Tees

"A regional referral pathway for active foot disease was set up in April 2015 for 8 NHS Trusts across north east England, which sets out when patients should be referred, who they should be referred to and how they should be referred.

It has helped to ensure that all patients with diabetes requiring care for active foot disease are referred correctly and seen in a timely manner, and is consistent with the recently updated NICE guideline on diabetic foot problems (NG19), which recommends that robust protocols and clear local pathways are in place for the continued and integrated care of people across all settings."

Implementing an active foot disease pathway for people with diabetes in South Tees
Diabetes Care Centre, The James Cook University Hospital
NICE Shared Learning example
July 2016

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The cost-effectiveness of testing strategies for type 2 diabetes: a modelling study

"Based on the multiethnic LEADER population, among individuals currently attending NHS Health Checks, it is more cost-effective to screen for diabetes using a HbA1c test than using a FPG test. However, in some localities, the prevalence of diabetes and high risk of diabetes may be higher for FPG relative to HbA1c than in the LEADER cohort."

The cost-effectiveness of testing strategies for type 2 diabetes: a modelling study 
Gillett M, Brennan A, Watson P, Khunti K, Davies M, Mostafa S, et al.
Health Technology Assessment 2015;19(33)

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Advice from NICE on Medicines Optimisation of Key Therapies

NICE have released a number of evidence-based Key Therapeutic Topics to support medicines optimisation. Access them below:

• Antibiotic prescribing – especially broad spectrum antibiotics (KTT9)
• First-choice antidepressant use in adults with depression or generalised anxiety disorder (KTT8) 
• Low-dose antipsychotics in people with dementia (KTT7)
• Hypnotics (KTT6)
• High-dose inhaled corticosteroids in asthma (KTT5)
• Omega-3 fatty acid supplements (KTT4)
• Lipid-modifying drugs (KTT3)
• Renin-angiotensin system drugs (KTT2)
• Wound care products (KTT14)
• Non-steroidal anti-inflammatory drugs (KTT13)
• Type 2 diabetes mellitus (KTT12)
• Minocycline (KTT11)
• Three-day courses of antibiotics for uncomplicated urinary tract infection
• Laxatives (KTT1)

Duration of participation in continuous quality improvement: a key factor explaining improved delivery of Type 2 diabetes services

"Type 2 diabetes service delivery could be improved through long term commitment to CQI, encouraging regular attendance (for example, through patient reminder systems) and improved recording and coordination of patient care in the complex service provider environments that are characteristic of non-remote areas. "

Duration of participation in continuous quality improvement: a key factor explaining improved delivery of Type 2 diabetes services
V Matthews et al.
BMC Health Services Research 2014, 14:578  doi:10.1186/s12913-014-0578-1

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Improving the value of diabetes care in Slough

"The Commissioning for Value Insight pack for Slough CCG identified that diabetes presented an opportunity for both quality improvement and financial savings. These opportunities were indicated by higher numbers of non-elective admissions compared with similar CCGs and also higher prescribing costs for conditions resulting from complications in cases of diabetes that were not well controlled."

Slough CCG: Improving the value of diabetes care in Slough (Right Care casebook)
N Nanda, R Sultana
October 2014

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Delivering High Value Care Pathways

"In this scenario we examine a typical long term condition pathway, comparing a sub-optimal but typical scenario against an ideal pathway. At each stage we have modelled the costs of care, both financial to the commissioner but also the impact and cost on the patient, family and their contribution to society. We show how the Right Care methodology can help clinicians and commissioners to improve the value of the care pathway."

Delivering High Value Care Pathways – Paul Adams – a commissioning scenario
A typical Long-Term Conditions story and how the NHS Right Care approach can help to achieve better value
NHS Right Care
August 2014

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Relational coordination amongst health professionals involved in insulin initiation for people with type 2 diabetes in general practice

"Given the need for coordination between specialist and generalist care for the task of insulin initiation, this study's results suggest the need to build relationships and communication between specialist and generalist health professional groups and the potential for DNE?s to play a boundary spanner role in this process."

Relational coordination amongst health professionals involved in insulin initiation for people with type 2 diabetes in general practice: an exploratory survey
J Manski-Nankervis, I Blackberry, D Young, D O’Neal, E Patterson, J Furler
BMC Health Services Research 2014, 14:515  doi:10.1186/s12913-014-0515-3

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Developing recommendations to improve the quality of diabetes care in Ireland

"Our results reflect the dynamic nature of the policy process and the importance of timing. The results highlight the limits of rational policy making in the face of organisational and fiscal upheaval."

Developing recommendations to improve the quality of diabetes care in Ireland: a policy analysis
SM McHugh, IJ Perry, C Bradle, R Brugha
Health Research Policy and Systems 2014, 12:53

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Changes in costs and effects after the implementation of disease management programs

"After one year we have found indications of improvements in level of integrated care for cardiovascular risk patients and lifestyle indicators for all diseases, but in none of the diseases we have found indications of cost savings due to disease management programs. However, it is likely that it takes more time before the improvements in care lead to reductions in complications and hospitalizations."

Changes in costs and effects after the implementation of disease management programs in the Netherlands: variability and determinants
A Tsiachristas, J Murray Cramm, AP Nieboer, MPMH Rutten-van Mölken
Cost Effectiveness and Resource Allocation 2014, 12:17

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Using health worker opinions to assess changes in structural components of quality

"Compared to usual care, managed care was significantly associated with better process in terms of diabetes care, fewer secondary care consultations and lower health care costs. The same trends were seen for protocolized care, however they were not statistically significant."

Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial
A van der Heijden, et al.
BMC Health Services Research 2014, 14:280

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Positive Cardiometabolic Health Resource

"This clinical resource supports the implementation of the physical health CQUIN http://www.england.nhs.uk/wp-content/uploads/2014/02/sc-cquin-guid.pdf which aims to improve collaborative and effective physical health monitoring of patients experiencing Serious Mental Illness. It focusses on antipsychotic medication for adults"

Positive Cardiometabolic Health Resource: an intervention framework for people experiencing psychosis and schizophrenia
DE Shiers, I Rafi, SJ Cooper, RIG Holt
Royal College of Psychiatrists
2014 update

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Improving diabetes care through examining, advising, and prescribing

"We will conduct a two-armed cluster randomised controlled trial in 44 general practices in the North East of England to evaluate a theory-based behaviour change intervention. We will target improvement in six underperformed clinical behaviours highlighted in quality standards for type 2 diabetes"

Improving diabetes care through examining, advising, and prescribing (IDEA): protocol for a theory-based cluster randomised controlled trial of a multiple behaviour change intervention aimed at primary healthcare professionals
J Presseau, G Hawthorne, FF Sniehotta, N Steen, JJ Francis, M Johnston, J Mackintosh, JM Grimshaw, E Kaner, M Elovainio, M Deverill, T Coulthard, H Brown, M Hunter, MP Eccles
Implementation Science, 2014, 9: 61

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Blood Sugar Rush: Diabetes time bomb in London

"The London Assembly Health Committee has sought to tease out what is driving the increase in Type 2 diabetes across London, and how the delivery of diabetes care is managed and where improvements can be made in providing that care."

Blood Sugar Rush: Diabetes time bomb in London 
London Assembly Health Committee
April 2014

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