‘Quality’ calls part of measures suggested on back of SMBG consultation
An expert panel has responded to NHS England calls for the prescribing of cheaper blood glucose test strips for type 2 diabetes by advocating quality and calling for independent testing of equipment.
Last month the organisation launched a three-month consultation on measures it says aim to “ensure consistency” and encourage commissioners and prescribers to consider “cost-effective options”, including lower cost test strips for people with diabetes.
In response, The iDEAL (Insights for Diabetes Excellence, Access and Learning) Group has urged prescribers to consider quality as part of a raft of measures outlined in a position statement, as well as suggesting:
- An independent evaluation of all SMBG (self-monitoring of blood glucose) strips and meters available in the UK based on internationally-recognised performance, accuracy and safety standards, prior to procurement by the NHS and recommendation to people with diabetes.
- The standardisation and benchmarking of good quality, accurate blood glucose systems so CCGs can use valid clinical data, not simply a costing tool to arrive at prescribing policies that favour people with diabetes.
- The introduction and piloting of a Key Performance Indicator (KPI) for primary care practitioners relating to the provision of diabetes-related education, using a variety of different approaches depending on each individual’s needs.
- Adoption of culturally appropriate approaches in primary care such as the ‘Stepping Up’ approach for effective and planned diabetes care.
iDEALemphasised the need to focus on the performance, quality, safety, accuracy and choice of blood glucose monitoring systems, together with education and support to meet each individual’s needs when introducing or using SMBG in people with type 2 diabetes.
The position statement concluded: “The key recommendations in this position statement should harness professional expertise and patient experience to generate consensus in networking, sharing of excellence in practice, research, clinical effectiveness and knowledge outreach to improve care.
“When implemented, they shall reduce clear and unacceptable variations in quality and processes of care for people with diabetes, while improving knowledge, effective education, care abilities and engagement of practitioners and empowerment of people living with diabetes.”
‘Lack of independence’ over testing
The 2018 iDEAL White Paper raised concerns at the absence of an independent system to verify blood glucose testing device performance. The position statement said: “Currently, each manufacturer self-reports their CE marking for their product. However, several devices are currently being utilised which have been shown not to meet the performance standard required in an independent laboratory.
“Critically, recent evidence Heald et al (2018) and McQueen et al, (2018) derived from real-world blood glucose results from over 150,000 people with showed that “use of more variable/less accurate SMBG is associated both theoretically and in practice with a larger variability in measured….HbA1c.”
Calls for key performance indicators
Expanding on the introduction of Key Performance Indicators (KPI) to measure and record individualised education, the position statement suggested the measures would be part of a regular quality measurement in the diabetes care pathway relating to SMBG measurements.
It went on to state: “This maintains accountability and is an important part of NICE (2015) guidance on performance and quality in practice, this also accords with the Health Quality Improvement Partnership (2016) Guidance. The outcome measures of this KPI are the recorded actions of the outcomes of SMBG and knowledge gain in each individual. This can be measured in terms of self-confidence, HbA1c, knowledge gain and quality of life. A pilot site introduction in general practice of the KPI will occur initially before a national roll out by iDEAL.”
The iDEAL Group is supported by an unrestricted educational grant from Ascensia Diabetes Care.
The group was established to review current practice across the NHS, in order to assess and recommend innovative ways to improve care pathways for people with diabetes. It was launched in July 2018.
To view the position statement, click here