Post on 05-Aug-2020
transcript
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NHS Diabetes Prevention
Programme: The Journey so Far
Professor Jonathan Valabhji
National Clinical Director for Obesity and Diabetes, NHS England
Consultant Diabetologist, Imperial College Healthcare NHS Trust
Adjunct Professor, Imperial College London
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5 Year Forward View 2014
“The future health of millions of children,
the sustainability of the NHS, and the
economic prosperity of Britain all now
depend on a radical upgrade in
prevention and public health”
5 Year Forward View - Prevention
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• Available for those individuals who have non diabetic hyperglycaemia (at high risk of Type 2 diabetes)
• Programme over 9 months to support long term changes in lifestyle to lower risk, including:
• Achieving a healthy weight
• Improving nutrition
• Increasing physical activity
• Significant evidence that Type 2 diabetes can be prevented through these changes
The NHS Diabetes Prevention Programme
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• Current Framework achieved 100% programme coverage of England earlier this year.
• To date over 230k have been referred, around 104k initial assessments and over 50k have attended a first intervention session.
• In 2017/18 the programme exceeded its Mandate and FYFV targets and the programme is ahead of profile to achieve its 2020 Mandate target of 100k on programme per year.
Progress to date
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• First wave of national roll-out
• 27 local health economies – 50% coverage of England
• 43,000 referrals, 59% conversion to attendance
Evolution - 2016/2017
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• Second wave of national roll-out
• 13 larger geographies - 75% coverage of England
• 182,000 referrals, 78,000 attended initial assessment
Evolution - 2017/2018
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Characteristics of participants
44%
55%
45%
55%
0%
10%
20%
30%
40%
50%
60%
Male Female
Pe
rce
nta
ge
Sex
2016/17 2017/18
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
18-24 30-34 40-44 50-54 60-64 70-74 80-84
Pe
rce
nta
ge
Age
2016/17 2017/18
19%20% 20% 20% 21%20%
21%
23%
19%17%
0%
5%
10%
15%
20%
25%
IMD 1(Most
deprived)
IMD 2 IMD 3 IMD 4 IMD 5(Least
deprived)
Pe
rce
nta
ge
Deprivation quintile
2016/17 2017/18
26%
67%
7%
19%
69%
13%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Asian, black, mixed,other
White Unknown
Pe
rce
nta
ge
Ethnicity
2016/17 2017/18
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Initial analysis of completers to March 2018
• 52% of participants attended 8 sessions or more (out of 13 sessions)
• Mean weight change for completers -3.2kg (-3.1 to -3.4kg)
• Mean weight change for all (intention-to-treat, last observation carried
forward) -2.3kg (-2.2 to -2.4kg)
• Percentage mean weight change of -3.8% (-3.6 to -4.0%)
• Mean weight change for all (intention-to-treat, last observation carried
forward) -2.7% (-2.5 to -2.8%)
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Evolving the Healthier You NHS Diabetes Prevention ProgrammeOpportunities for Digital Health Interventions
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Evaluating the NHS Diabetes Prevention Programme (NHS DPP): the
DIPLOMA research programme
Diabetes Prevention – Long term Multimethod Assessment
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NHS Diabetes Prevention
Programme: A user perspective
Bridget Hopwood – Diabetes UK
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• Public consultation hosted by Diabetes UK
• 215 completed on-line survey responses
• Also gained some more in-depth feedback from attending provider
events and DPP sessions around the country.
• 43 respondents
• 2 x focus groups and 1:1 interviews
• Range of backgrounds / demographics
Context
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Referral
Initial
Assessment Intervention
Sessions
Delivery:
Remote vs
f2f
Completion
Journey through the NHS DPP
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“GPs should attend too”
“They didn’t know much about it. It was
quite frightening, I knew something was
wrong but they just gave me a phone
number to ring”
Referral
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“People need to know more. It
was too vague why the course is 9 months.”
“Tell them why it is important – it is about continual support; emphasise the lifestyle element – about making a lifestyle change . Then there is a perception from day 1 about how it is for your life
longer term. Focus your mind.”
Referral
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“Use ‘scare tactics’ …like
on cigarette boxes”
“I got a separate letter, so I could do
what I wanted – go, or not go. The
seriousness of it was not conveyed
by the GP”
Referral
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Programme delivery: Face to face
“I know it'll be hard but being with
other people will influence me and - I
hope - add to my resolve to make a
change in my life.”
“…turning up is part of the
commitment”
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“The consequences and complications
section…was very emotional and shocking.
Here you have people around you to
support you and help you…”
“Wouldn't enjoy it as much not in a
group. Coming out of the house is
important, I have nowhere to go, not
many friends”
Programme delivery: Face to face
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Programme delivery – Remote support
“A very good idea that will help
the housebound & disabled public”
“As a shift worker I would find it difficult to get to
a location at the same time every week due to
work commitments.”
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“Doing it in your own time and pace
makes it easier to complete with other
commitments”
“I would not be comfortable in a
group and more likely to drop out of
the programme. I would be more
likely to complete the programme if
it was delivered remotely.”
Programme delivery – Remote support
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End of programme
“Wonderful. Everything about it was
wonderful – portion control, exercise. I feel
‘born again’, fresh and new”
“It has opened my eyes. I learnt how to
make changes, I've made changes to
my diet. I have learnt a lot of
information I didn't know.”
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“After 9 months it stops completely. Need
something else afterwards to maintain that
lifestyle, on-going”
“Hope I can be on track once I've finished. Need
to keep 'checking in', need incentives to carry
on”
“Linking in with other things would stop the void
after programme finishes.”
End of programme
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Summary• Referral process: referrer needs to be knowledgeable about the
programme, T2 Diabetes and the seriousness of it.
• Pre-course communication is vital – needs to be regular to maintain
momentum, manage expectations and reduce anxiety.
• Group learning likely to be more effective but remote provides a
flexible alternative and increases reach
• Programme itself needs to be flexible, tailored to local communities
and provide opportunities for 1:1 support where possible
• Support at end of programme needed – regular check-ins or links with
existing community services etc.
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NHS Diabetes Prevention
Programme: Next Steps
Tom Newbound – National Implementation Lead
NHS England
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• Current Framework expires March 2019
• Opportunities for improvement:
• Currently up to half of people referred decline the service and a further percentage don’t progress to group sessions;
• For a range of individuals there are barriers to committing to and attending a face to face intervention;
• Remote can support attendance and retention on face to face services;
• Digital diabetes prevention services provide an opportunity to extend access to those who decline or do not progress onto the face-to-face service.
The Provider Framework
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• We have undertaken analysis of the characteristics of those who decline or do not progress through the current face to face service.
• In order of importance characteristics of those declining are that they are of working age, deprived and from a BAME demographic.
• If we can show that digital delivery routes boost uptake for these demographics we can raise overall performance and target health inequalities.
Who could benefit from digital?
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• Evidence base for digital approaches not yet as well developed
• Important that patients are offered a high quality service with a robust evidence base
• Taking a novel approach to the inclusion of digital, where patients are offered digital at the point where it is clear that face to face is not a suitable route of access for them
• Programme therefore continues to offer a single point of access to patients and primary care for support preventing their diabetes
Incorporating Digital
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• The main observable health inequalities in diabetes relate to who
develops diabetes, with South Asian populations up to 6 times more
likely to develop diabetes than white populations and black populations
3 times more likely;
• Future allocation of programme capacity from 2019/20 will be linked to
both social deprivation and BAME prevalence;
• Outcome based payment for providers focused on both social
deprivation and BAME;
• Digital services likely to be of greater benefit proportionally to BAME
people as they are on average younger.
Inequalities
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Next Steps
• Invitation To Tender closes 15 Oct
• Framework Provider approvals Dec 2018
• Implementation begins from Jan 2019
• 40% of England will take up these new services from July 2019
• First time that we will offer a digital service at this scale so implementation challenges to overcome
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• NHS England will continue to commission and fund the NHS DPP nationally
for at least a further 3 years from 19/20.
• Digital included to widen access, but only in addition to face to face, does not,
and will not replace.
• Clear focus on widening access and supporting our working age cohorts.
• New providers and framework, and therefore will be an implementation phase.
• Programme working, with weight loss in line with the RCT evidence base that
we have drawn from.
Key headlines