Summary
Diabetes is one of the leading causes of certifiable sight loss amongst the working age population in the UK. Improving self-management of diabetes and uptake of Diabetic Retinopathy Screening (DRS), eye examinations and attendance at Diabetic Retinopathy (DR) Outpatients clinics is essential to prevent complications such as sight loss. This project, funded by RNIB and the Department of Health, promoted self-management and engagement of friends, family and the wider community to help people live well with diabetes. Low cost interventions included the DRS Service sending a text appointment reminder and a ‘ring and remind’ service in DR Outpatient clinics. Attendance at DRS increased overall by 10%, with those for patients receiving the full suite of interventions up by 15%.
Results
Attendance at DRS increased overall - by 15% for patients receiving all interventions compared to 10% among those only getting the additional text appointment reminder. There was a 45% increase in people invited to Diabetic Retinopathy (DR) outpatient clinics – and among the target population of Pakistani patients, non-attendance (DNA) fell from 27% to 23% compared to an average fall in DNA from 24% to 23%. A postal questionnaire survey of Pakistani patients aged 40 to 65 indicated an increased understanding of eye health and its relationship to diabetes.
Challenge
Diabetes is one of the leading causes of certifiable sight loss amongst the working age population in the UK: 7% of all new certificates of vision impairment are due to diabetic eye disease. In collaboration with local communities and health care providers in Bradford, RNIB used a co-production approach to develop a range of interventions to improve self-management, access to services and thereby help reduce avoidable complications. Six per cent of the adult population of the UK are currently diagnosed with diabetes (3.2 million people). This is set to rise to 9.5% of the population by 2030. An estimated 10% of NHS expenditure is spent on tackling diabetes. Living in socio-economic deprivation is closely linked to developing diabetes and people of South Asian ethnicity are up to six times more likely to have the condition compared to the general population.
Objectives
To develop and test interventions to increase access to eye care services for people with diabetes and improve self-management to prevent complications including avoidable sight loss. The key target population was people living with diagnosed diabetes, aged 40 to 65, of Pakistani heritage and living in Keighley, and the aim was to increase uptake of Diabetic Retinopathy Screening (DRS) and eye examinations, and to reduce non-attendance at diabetic retinopathy outpatient clinics.
Solution
Interventions were designed following workshops with stakeholders from across the diabetes and eye care services, along with voluntary sector and community members, in a series of workshops. The intervention ideas were then taken out to community groups for a reality check. These included an appointment text reminder, a ring and remind service for DR outpatient clinics, a self–care folder, ‘Living Well with Diabetes’, to enable people to keep a record of appointments, monitor blood pressure, HbA1c, cholesterol, weight/BMI and medications. Health professionals including GPs, practice nurses, pharmacists and opticians were encouraged to give patients consistent messages about living well with diabetes. A programme of community education and awareness raising included community and religious leaders giving key messages about living well with diabetes.
Learnings
The co-production approach to designing the interventions secured buy-in and generated a sense of ownership amongst key stakeholders. A whole systems approach which involved amending existing health services and engaging the wider community ensured all but one of the interventions (the ring and remind service) were sustainable beyond the lifetime of the project. Engaging the wider community helps to ensure that people with diabetes are not tackling their condition in isolation but rather in partnership with friends, family and the wider community. Training and supporting GP Practice staff to adopt a motivational interviewing approach to support patients to improve diabetes self-management was key to success. As the project evolved it became evident the solutions developed to help Pakistani people living with diabetes were suitable for patients of all ethnicities. The barriers and challenges facing this community resulted from socio-economic deprivation and low health literacy rather than ethnicity.
Evaluation
London School of Hygiene and Tropical Medicine conducted the independent evaluation using a range of different tools including: routine DRS and DR outpatient clinic data, monitoring logs kept by DRS staff and opticians, pre- and post-intervention postal questionnaire survey in the intervention site and a comparison site, and qualitative interviews with professionals and patients.
