South London insulin pump uptake improved
Insulin pump uptake has been improved by 21.4 per cent in south London thanks to a collaborative project which streamlined clinics for people with type 1 diabetes in the area.
Evidence indicates that between 15 to 20 per cent of adults with type 1 diabetes can benefit from insulin pump therapy, but only approximately 6 per cent use a pump, according to the latest UK Insulin Pump audit.
So the Health Innovation Network, which is the Academic Health Science Network for south London formed the Diabetes Improvement Collaborative which brought together industry, healthcare professionals, managers and service users.
Type 1 diabetes is an autoimmune disease causing the loss of insulin production, which usually presents in people under 30 affecting over 370,000 adults in the UK.
The first clinical trial on insulin pump therapy took place at Guy’s Hospital back in 1978, however far fewer UK adults use pumps than in comparable countries ― approximately 6 per cent of people with type 1 diabetes use an insulin pump according to the latest UK Insulin Pump audit 2013. In Europe, insulin pump uptake on average is 15 per cent while in the US it’s around 40 per cent.
Diabetes charity INPUT‘s chief executive, Lesley Jordan, herself a pump user, said: “Other countries recognised the benefits of insulin pump therapy earlier than the UK and have been more proactive in ensuring that diabetes clinics are equipped to provide it.
“Healthcare professional training is an essential component of delivering insulin pump therapy; the UK must do a better job of both ensuring our diabetes clinicians are able to recognise when patients would benefit from a pump and supporting patients to achieve the goals of pump therapy.”
Diabetes is a key theme for the Health Innovation Network. Dr Natasha H Patel who is the joint diabetes clinical director at the Health Innovation Network, and a consultant diabetologist from Guys’ and St Thomas’ NHS Foundation Trust and Dr Charles Gostling a GP from Lewisham helped with the programme that focuses on access to technology, integration of care and supporting self-management for people with diabetes.
The Health Innovation Network wanted to know why uptake of insulin pump therapy was so low and undertook a local study in 2014 of its 12 borough south London patch. The study found insulin pump therapy uptake was between 3 per cent and 15 per cent depending on borough, based on data supplied by participating trusts.
On the back of this local study, the Diabetes Improvement Collaborative was set up to improve outcomes for people with type 1 diabetes across south London through access to appropriate technologies. There was also interest from three north London trusts who joined the seven south London trusts in the collaborative.
Dr Patel said: “Having spoken with clinicians at the 10 trusts across London and considered the issues and barriers to increasing pump uptake, we decided to bring the teams together in a collaborative.”
Experience and learning
The Diabetes Improvement Collaborative was established to give teams the service improvement tools to streamline their service, factoring in issues such as the large numbers of children using pumps who transfer over into adult diabetes clinics. The collaborative emphasised ways of providing holistic care, including care planning and psychological support.
I’ve really enjoyed being involved and I think real progress has been made which is a great result
The Diabetes Improvement Collaborative itself included clinical experts from secondary care, insulin pump users and three industry partners: Roche Diabetes Care Ltd., Boehringer Ingelheim Ltd., and Johnson & Johnson (Janssen and Animas).
Four workshops for multidisciplinary secondary care diabetes teams were held over 10 months between November 2014 and July 2015.
The trusts which took part included Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust, St George’s University Hospitals NHS Foundation Trust, Epsom & St Helier University Hospitals NHS Trust, Lewisham & Greenwich NHS Trust, Croydon University Hospital NHS Trust, and Kingston Hospital NHS Foundation Trust, Imperial College Healthcare NHS Trust, the Royal Free London NHS Foundation Trust and Whittington Health.
Each workshop was attended by around 60 people made up of doctors, specialist nurses, allied health professionals, managers and service users from across London.
To support the implementation of the teams’ plans, tailored onsite support was delivered by the Health Innovation Network and NHS Elect between workshops. Teams also had access to the Health Innovation Network’s online collaboration platform. In addition, it was essential that people with type 1 diabetes were part of the collaborative to share ideas, experience and learning.
Service improvements implemented through the collaborative include capacity and demand planning for local type 1 populations; streamlining access to patient education courses (an important step prior to pump initiation); developing the roles of clinic support staff in order to release specialist nursing and dietitian time; developing new multidisciplinary clinics; and the creation of a new database to improve the consistency of type 1 care.
Clare Neely, lead diabetes specialist nurse, at the Kingston Hospital NHS Foundation Trust, said: “Looking at what others are doing and matching it to our service to see how we can improve, how we can develop and find out what does work has been most valuable.”
The collaborative emphasised the fact that high quality pump services are always found within a high quality diabetes service and the strong voice of insulin pump users at each workshop ensured continuous focus on this holistic approach.
In the quarter leading up to the first collaborative workshop in November 2014, the average number of people with type 1 diabetes beginning pump therapy across all sites averaged 17 a month. In the quarter since the final workshop, (July 2015-Oct 2015), this has almost doubled to 29.
It is estimated that the current level of insulin pump usage across south London is now 10.9 per cent which is higher than the UK average of 6 per cent and this is thanks to the work of the Health Innovation Network collaborative and its participants.
Patient representative, Claire Williams, said: “I’ve really enjoyed being involved and I think real progress has been made which is a great result.”
A short film on the success and achievements of the Diabetes Improvement Collaborative can be viewed below or via this link: https://vimeo.com/145277969