Meet the team
- Dr Hermione Price,Joint Diabetes Specialty Lead, Wessex Clinical Research Network
- Dr Ian Glass,GP Partner
- Dr Paul O’Halloran,GP Partner
- Dr Neil Moody-Jones,GP Partner
- Neil Hardy, Associate Director Medicines Optimisation, West Hants CCG
- Dr Brady McFarlane, Co-director Memory Assessment Research Centre
- Dr Jay Amin, Consultant in Old Age Psychiatry
- SHFT Frailty team,Lymington
What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?
Enabled by the current close working relationships across clinical and social care networks, bringing together GPs, care home providers and specialist community-based clinical services has generated renewed interest in identifying simple, time-saving interventions that promote quality-of-life without overwhelming frail and vulnerable patient living with Type 1 Diabetes (T1D) and their carers. Engaging with service providers, device manufacturers and clinical scientists, we have mapped out a future where vulnerable patients have diabetes management devices remotely connected to the community diabetes team, with their data driving proactive intervention to reduce patient risk.
Providing diabetes management data, such as insulin delivery, carbohydrates consumed and glucose measurements are available, T1D patient-specific advice remains feasible despite the limitations of virtual clinics. However, for patients identified as frail or vulnerable, including those living with T1D in a care home setting, the loss of face-to-face contact is often combined with the loss of this valuable data stream.
What does your project aim to achieve?
Although virtual clinics and remote data collection have been embraced by someT1D patients, frail and vulnerable patients, including those with cognitive decline, are in danger of being left behind during this transition and yet are likely to be in some of the greatest need of specialist clinical assistance. To redress this, commissioners, General Practice and care providers have indicated their enthusiasm to facilitate further development of diabetes data management and analysis to allow for timely, remote specialist clinical intervention. Local CCGs already fund the core continuous glucose measuring (CGM) technology and all parties now wish to see use of this technology embedded with those T1D patients categorised as frail. We aim to establish the framework of safely achieving that roll-out, including provision of carer – and, where appropriate, patient – training and ensuring the clinical data generating by these devices remains accessible and visible, even if direct face-to-face contact is not feasible.
How will the project be delivered?
We will leverage existing good system-wide support and communication, including local commissioners and care homes. The community diabetes consultant and nursing team’s existing engagement and experience with this population will be supplemented with specialist expertise from regional dementia and frailty care teams and knowledge from local GP partners.
Having established a baseline of glucose management metrics (including time-in-range, frequency of hypo- and hyperglycaemic events) for this population, planned PDSA cycles include evaluating the impact of local availability of CGM and the addition of a clinic prioritisation dashboard. Clinical scientist expertise will be used to consolidate tens-of-thousands of patient-specific data-points into simple, accessible metrics, generating a dashboard of priority patients and enabling pre-emptive action (e.g. reducing basal insulin).
Cycles will include representatives from patient and carer groups to ensure that apparent improvements in glucose management are not generated at the expense of patient quality-of-life or excessive carer / clinician workload.
How is your project going to share learning?
This project offers potential insight into the use of QI in tackling and assessing changes in the care of other long-term conditions in frail and vulnerable patients, including those in residential care. With a community-based specialist care team already in place and connected to the local strategic clinical and research networks, paths of dissemination across the immediate region already exist. Existing connections to the Association of British Clinical Diabetologists (ABCD) and ongoing dialogue with Diabetes UK give natural avenues to disseminate learning opportunities and to receive valuable feedback from clinician, patient and commercial diabetes technology manufacturers.
Progress through the PDSA cycles explored, including anonymised patient and clinician journey mapping, will be made available via the Documents section on the Q website and offered to the Wessex AHSN, ABCD and Diabetes UK for sharing via their online resources.
How you can contribute
- Experience and expertise delivering education in care homes
- Engagement from those with experience and expertise of care home environment (initial scoping suggests CCG care home pharmacy team able and willing to support)
- Challenge and ideation directly from this patient population, along with their carers, families and staff
- Engagement via diabetes charities, clinical groups and advice on formats likely to reach patients, carers and clinical teams
- Technical and practical expertise in deploying remote-monitoring devices into community and/or care homes
- Collaborators to sustain delivery and development beyond this project's timeframe
- Networking beyond Wessex and Dorset to ensure lessons learnt elsewhere are identified and common issues can be sustainably tackled (SE SCN engaged)
- Q members active in primary care - primary care collaboration key to identify patient group, engagement with aims and objectives, for their local health care intelligence
- Beyond Q, we intend to work with a local forum for care home managers
|30 Mar 2021||NB Indicative timeline, acknowledging complex patient group and covid challenges|
|31 Mar 2021||Formation of core project team|
|30 Apr 2021||Ethics submission for blinded CGM in patient population|
|30 May 2021||Formation of sub-teams targeting dementia and care home settings|
|30 Jun 2021||Start of PDSA 1: CGM & education provision|
|31 Aug 2021||Clinic dashboard architecture|
|31 Aug 2021||Patient and carer visits to establish context of diabetes care|
|31 Aug 2021||Subject enrolment for blinded CGM data complete|
|30 Sep 2021||Collection of blinded CGM data (10 days)|
|31 Oct 2021||Start PDSA2: Clinic dashboard algorithm development for proactive patient/carer contact|
|30 Nov 2021||Final review patient acceptance of blinded CGM data collection|
|30 Nov 2021||Verify challenges and select measures from blinded CGM data|
|31 Dec 2021||Initial patient and carer training CGM curation|
|31 Jan 2022||Collection of unblinded CGM-data (spread over three months for PDSA1)|
|31 Jan 2022||Patient and carer training CGM delivery|
|31 Mar 2022||Per subject CGM-data review to update training and education offer|
|30 Apr 2022||End of PDSA 1 series|
|30 Apr 2022||Unblinded CGM data analysis to establish CGM + education impact|
|31 May 2022||Clinic dashboard development and review as CGM data increases|
|31 May 2022||Retrospective review- efficacy of clinic dashboard algorithm for population studied|
|30 Jun 2022||End of PDSA 2 series|
|31 Jul 2022||Solution sustainability and dissemination|