Alphabet Strategy for Diabetes Care An international evidencebased, patientcentred approach - PowerPoint PPT Presentation

Loading...

PPT – Alphabet Strategy for Diabetes Care An international evidencebased, patientcentred approach PowerPoint presentation | free to view - id: 107913-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Alphabet Strategy for Diabetes Care An international evidencebased, patientcentred approach

Description:

Alphabet Strategy for Diabetes Care An international evidencebased, patientcentred approach – PowerPoint PPT presentation

Number of Views:136
Avg rating:3.0/5.0
Slides: 61
Provided by: commonheal
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Alphabet Strategy for Diabetes Care An international evidencebased, patientcentred approach


1
Alphabet Strategy for Diabetes CareAn
international evidence-based, patient-centred
approach
  • Vinod Patel
  • Bsc (Hons), MD, FRCP, DRCOG, MRCGP
  • S. R. Joshi, J Morrissey, P Saravanan, L
    Varadhan, A Gopinath, J D Lee, S Shaikh, D
    James, P Sear, Jo Wilson, T Ritchie, R Nair

George Eliot Diabetes Centre, George Eliot
Hospital NHS Trust, Nuneaton, UK Lilavati
Hospital Research Centre, Mumbai, Maharashtra ,
India
2
Diabetes CareThe Alphabet Strategy Approach
  • Introduction
  • The Strategy
  • The Evidence
  • Health Passport
  • Conclusion

3
Diabetes Care The Complications
  • Retinopathy
  • Most common cause of blindness in people of
    working age

Macrovascular disease 24 fold increased risk
of coronary heart disease and stroke, 75 have
hypertension
Nephropathy 16 of all new patients needing
renal replacement therapy
Foot problems Commonest cause of non-traumatic
amputation
  • Erectile dysfunction
  • May affect up to 50 of men with long-standing
    diabetes

The Audit Commission. Testing Times. A Review of
Diabetes Services in England and Wales, 2000.
4
Diabetes Care the evidence base
WOSCOPS 4S HPS ASCOT-LLA LIPID
  • UKPDS

RENAAL IRMA
DPP
HOPE DCCT EDIC
STENO-2 CARDS EUCLID
5
Diabetes Care Components of Care
Weight loss Regular exercise Dietary
modification
  • BP control

Cholesterol profile modification Multi-disciplina
ry
Smoking cessation Patient orientated
Foot screening ACE inhibitors AII
receptor blockers
Eye screening Statins
Aspirin
6
Diabetes UK Audit
  • Eye examination
  • 56.5 only
  • Range 16-100

HbA1c 70.1 Range 17-99
Blood Pressure 71.1 Range 33-100
Foot Examination 55.1 only Range 4-95
Malcolm Roxburgh. Diabetes UK Multi-Centre Audit
2000.
7
Excellence requires that important, simple
things are done right all the time. National
Service Framework for Coronary Heart Disease
Patel V, Morrissey J. The Alphabet
Strategy. British Journal of Diabetes Vascular
Disease. 2002.2158-59
8
Joint British SocietiesPrevention of CVDThe New
Guidelines
Alphabet Strategy
  • Advice
  • Education, self-management, smoking cessation,
    diet, physical activity, weight reduction
  • Blood Pressure
  • Target lt130/80
  • Audit standard lt140/80
  • Cholesterol
  • TC 4.0 mmol/l, LDL 2,
  • Consider HDL 1 men, HDL 1.2 women
  • Diabetes Control
  • Target HbA1c 6.5, audit lt7.5
  • Eyes
  • check yearly and refer if needed
  • Feet
  • check yearly and refer if needed
  • Guardian Drugs
  • Aspirin 75mg, ACE-I or ARBs, Statins

Vinod.patel_at_geh.nhs.uk
9
The Steno-2 Study a Summary
Steno Diabetes Centre Copenhagen, Denmark
  • 160 with T2D and microalbuminuria
  • 80 allocated to conventional treatment
  • 80 allocated to intensive treatment
  • Mean age 55.1 years
  • Mean follow-up 7.8 years

10
Steno-2 Targets Achieved
11
Steno 2 Event Reduction
12
Steno-2 CVD Event Reduction
13
Steno-2 13 years follow up data
14
Steno-2 Conclusion
A target driven, long-term, intensified
intervention aimed at multiple risk factors in
type 2 diabetes and microalbuminuria reduces the
risk of cardiovascular and microvascular events
by about 50.
15
Objective
  • Evaluate an innovative locally-created education
    strategy that encompasses patient education and
    effective evidence-based healthcare professional
    education.

16
Results
  • Healthcare Professional Education programme
  • Delivered over 100 times.
  • Evaluations have been consistently positive.
  • The most recent course was delivered under the
    auspices of the UN Development Fund in Bahrain.

17
Results
  • Practice Of Evidence-based Medicine Audit
  • Over 5 years BP, Cholesterol, Diabetes control,
    Eye and Feet screening improved with a
    significant improvement in the cardiovascular
    risk score (31.2 to 23.7 plt0.05).
  • Results are similar to those intensively treated
    cohorts of UKPDS and Steno-2.

18
Heart Disease Risk Score
UKPDS T0 vs. Tfu pNS Tadj vs. Tfu plt0.001
UKPDS 10 year absolute CHD risk
n315
19
GAIA Project 3275 patients, 35 centres, 25
countries
20
Objective
  • To investigate the feasibility of implementing
    the Alphabet Strategy in diabetes centres
    internationally.
  • Aims
  • To collect global comparable data on current
    diabetes care in the form of the Alphabet
    Strategy.
  • To investigate the possibility of using the
    strategy to regulate diabetes care, to aid health
    care professionals and ultimately to improve the
    outcome of international practices.

21
Results
  • GAIA Survey (Global Alphabet Strategy
    Implementation Audit)
  • In 35 diabetes centres in 25 countries, 57.5 of
    146 healthcare professionals felt likely to adopt
    the strategy. 84.5 felt it was evidence-based
    and 88.0 practical.

22
Total GMS2 points per centre
23
Conclusions
  • The Alphabet Strategy has the potential to be
    widely adopted as an evidence-based, practical
    strategy for diabetes care.
  • This study shows endorsement by healthcare
    professionals and patients.
  • Neither economic constraints nor language
    barriers should hinder willingness to improve
    diabetes care by adopting the Alphabet Strategy.

24
(No Transcript)
25
Sabiha Kausar and Asifa Akhtar
26
(No Transcript)
27
(No Transcript)
28
(No Transcript)
29
(No Transcript)
30
(No Transcript)
31
(No Transcript)
32
(No Transcript)
33
(No Transcript)
34
Results
  • Patient Education Programme
  • Knowledge in 100 patients, improvement from
    61.5 to 80.0 (plt0.01).
  • An expert patient programme has been created
    which involves patient studying the Alphabet
    Strategy materials and being accredited if the
    stipulated score is reached on the quiz.

35
Patient Survey
  • 96.7 understood the strategy. Diabetes control
    and Advice posters gave the most powerful
    information.
  • 36.7 found the Guardian Drugs poster the
    hardest
  • 36 stated their diabetes control required most
    attention.
  • 100 of patients stated they understood the
    importance of BP and diabetes control.
  • A mean score of 8.9/10 was given for usefulness
    and 90 found the experience enjoyable.

36
Benefits to patients
  • Educational tools help patients understand the
    main components of care in a clear and logical
    manner
  • The handheld records allows patients to know
    their BP, cholesterol etc and to track changes.
  • Clinical audit demonstrates that patients have a
    higher standard of care than before and higher
    than average.
  • We have demonstrated a potential reduction in CHD
    by 25 ( cardiac risk score reduced from 31.2 to
    23.7)

37
Patients views on the Alphabet strategy
38
(No Transcript)
39
The ABCD HEALTH passportHelping Everyone
Achieve Long Term Health
Evidence Base
Patient Education
Action Plan
40
(No Transcript)
41
(No Transcript)
42
Diabetes Passport
43
(No Transcript)
44
(No Transcript)
45
(No Transcript)
46
(No Transcript)
47
(No Transcript)
48
(No Transcript)
49
ASIAD Project
Alphabet Strategy Indian Application for
Diabetes An European Strategy applied in
outpatient setting in Asia
L Varadhan1, V Palanikumaran2, A Gopinath1, J
Morrissey1, V Patel3l NHS 1 George Eliot
Hospital NHS Trust 2 Shenbagam Hospital, Madurai,
India 3 Warwick Medical School, University of
Warwick, Coventry, UK
50
Results
  • ASIAD Study
  • Implementation in an economically-deprived Indian
    setting.
  • Main improvements (plt0.01)
  • cholesterol (60 to 90),
  • statin use (5 to 38),
  • aspirin use (6 to 71),
  • proteinuria assessment (48 to 93).

51
Alphabet Strategy Indian template
52
Blood Pressure Cholesterol
53
Guardian drugs
54
Benefits to staff
  • This strategy has resulted in closer team working
    of all members of the team, effectively towards a
    very high standard of care.
  • This includes practice nurses, general
    practitioners, hospital doctors, nurses,
    pharmacists, podiatrists and dieticians. The
    materials have been produced by the whole team.
  • The team feels empowered in the fact that a very
    high standard of care is being delivered.
  • Recruitment to our unit is excellent with most
    staffs members involved in dissemination of the
    strategy.

55
Vascular Swiss Army Knife
56
Diabetes Care Different Economic Circumstances
57
Conclusion
  • Alphabet strategy is an patient-centred,
    evidence-based, multi-professional template to
    ensure that all the main components of diabetes
    care are delivered effectively to a high
    standard.
  • It is free and public domain and has the
    potential to be easily adopted to any health care
    economy
  • High standards of diabetes care can be provided
    using this strategy.
  • We seek collaboration with you!

58
Alphabet Strategy for Diabetes Care
  • Advice
  • Education, self-management, smoking cessation,
    diet, physical activity, weight reduction
  • Blood Pressure
  • Target lt130/80
  • Audit standard lt140/80
  • Cholesterol
  • TC 4.0 mmol/l, LDL 2,
  • Consider HDL 1 men, HDL 1.2 women
  • Diabetes Control
  • Target HbA1c 6.5, audit lt7.5
  • Eyes
  • check yearly and refer if needed
  • Feet
  • check yearly and refer if needed
  • Guardian Drugs
  • Aspirin 75mg, ACE-I or ARBs, Statins

Vinod.patel_at_geh.nhs.uk
59
(No Transcript)
60
Actual contribution of each risk factor in
improving cardiovascular risk in Steno-2
UKPDS Risk Engine (Similar with Framingham)
Pacman graph Tadj to Tfu, n80
About PowerShow.com