Summary
Diabetes management is complex, requiring varying levels of knowledge, depending on the healthcare practitioner’s (HCP) role, in order to provide quality care to a person with diabetes. The foundations of optimal care lie in HCP education and competency maintenance. The Cambridge Diabetes Education Programme (CDEP) is a competency-based online diabetes platform supporting both non-diabetes specialist, and diabetes specialist, HCPs to demonstrate the diabetes skills relevant to their role through continuing professional development (CPD). CDEP is built on the UK national diabetes competency frameworks and utilises adult education principles and Miller’s Pyramid of Competency to underpin its functionality. For a diabetes training tool to be successful and widely used it needs to be fit for purpose, affordable, accessible and attractive to busy HCPs and commissioners. An online platform allows people to learn at a convenient time and pace. The cost is often more affordable because of the lack of travel and accommodation costs and time away from the office/family. Online registrations offer learning over a period of time for continuous competency updating. Online platforms can provide commissioners with objective staff engagement and utilisation data to link staff competency with clinical outcomes.
Results
New registrations have increased 51% over the past 12 months. CDEP offers 15 topics and has generated 8,000+ certificates. On average, over the last six months, 13 topics were completed seven days a week, with 1,369 topic certificates issued in the last three months.
An average evaluation of CDEP across all topics (5 June 2018) showed: 99.8% of CDEP users undertaking a topic (n=8053) either confirmed (13.6%) or improved their diabetes knowledge (86.2%). For those reporting an improvement, the breakdown across the three outcomes’ domains was: 88% reported an improvement in competence, 85% reported an improvement in confidence and 86% reported an improvement in familiarity with diabetes guidelines.
Dissemination and Sustainability
In 2014, CDEP was used within NHS Cambridgeshire and Peterborough CCG, mainly within general practice and acute Trusts. It has since widened its reach locally and throughout the UK. It attracts users from other health sectors, including community services, ambulance Trusts, mental health Trusts and nursing homes. It is available in 34% of CCGs in England. The five main objectives of CDEP are: provision of an e-learning programme that supports quality improvement in patient care and outcomes; enabling learning in informal settings; supporting the needs of all HCPs (registered and unregistered) in diabetes care; recognising progress and achievement, plus standardisingthe overall level of care for patients. Promotion of CDEP has been achieved via: publication of outcomes data; endorsing/accrediting bodies; success with awards, as well as word of mouth, email and social media marketing. Overall 70 CCGs offer or are launching CDEP, with 11,914 bulk licences purchased, of which 2,337 (20%) have been used. CDEP offers commissioners substantial post-sales support. Its initial development and pilot was funded by grants; it now generates its own revenue via registration fees and partnership/project working, such as with the south London Health Innovation Network. Traditional face-to-face training is valuable, but often not well attended and expensive to deliver on the large scales necessary to reach all healthcare staff working with people living with diabetes. Hence, CDEP offers ‘bite-size’ portions of training via a computer, tablet or smartphone. Most users are on the site for 20 minutes at a time, dipping in and out when convenient. However, getting busy HCPs engaged and then motivated to continue with CPD requires regular reminders, alongside partnership working with CCGs to set expectations of which topics staff should complete as a minimum. Some CCGs have included CDEP topic completion as part of their Locally Enhanced Diabetes Service requirements. Content development is led by the CDEP clinical team, with external experts providing advice and guidance. CDEP was advised the University of Cambridge’s School of Clinical Medicine regarding assessment methods and the design and writing of the content. However, meeting the needs of a broad range of staff working in various healthcare settings with differing degrees of diabetes knowledge is challenging and CDEP constantly strives to enrich its platform. New question formats and functionality will be launched in August 2018, with its next new topic: Structured Education, who, why and when?
Method
In order to deliver its aims in 2017-18, CDEP needed to: continue to provide an up-to-date, user-friendly, exciting platform that met the needs of the user via regular website changes and updates, regular existing topic updates and broken link fixing, along with new resources. It also needed to offer new topics for current users, drive new registrations, evaluate feedback and make changes, especially concerning why people registered and then were not active and why people started topics and did not complete them. It also had to seek timing accreditation from the Royal College of Nursing (RCN) and Royal College of General Practitioners (RCGP) and re-endorsement from the British Dietetics Association (BDA) and Cambridge University Health Partners (CUHP). Further, it needed to collaborate with other diabetes education providers to promote diabetes skills among HCPs to improve the minimum standards of care and undertake active marketing. Impact was monitored via CDEP website activity, successful endorsement/accreditation and internal audit.
