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As a new NHS England service specification is launched on diabetes transition, Newham’s DAWN scheme shows how the use of technology has led to successful results.
A pilot scheme in Newham helping young people keep on top of their diabetes care has rolled out Skype appointments to all patients as part of a successful four year trial.
Since launch in 2011 the Diabetes Appointments via Webcam in Newham (DAWN) scheme, web-based follow up is used routinely for young people aged 16-25 years, and 480 webcam appointments have been carried out, reducing ‘do not attends’ (DNA’s) from 30-50 per cent to 16 per cent.
The service was set up with the Health Foundation’s SHINE award (£75,000) and is thought to increase productivity and patient throughput by 22% – 28%, saving approximately £27 per consultant appointment in clinician time.
The service is offered by the Diabetes team at Newham University Hospital, Barts Health and supported by East London NHS Foundation Trust and Newham Clinical Commissioning Group
Desiree Campbell-Richards, research nurse at Newham University Hospital who has worked on the Skype project, said: “By giving young people the choice of using Skype we saw some patients who had disengaged with us come back to clinic.
“It wasn’t just about flexibility for the young people but about their confidence in the service and feeling able to have an honest connection with the clinicians.”
The scheme, which started off with young people but has now rolled out to all age groups, offers a regular clinic appointment on Skype for those patients who do not require physical examination. There is also a facility to seek advice through Skype messaging. This could be anything from advice on insulin dosage, verification of a lifestyle decision or a request for a conversation with a clinician if they have a concern.
Data security and confidentiality regulations are robust and made clear in the appointment agreement and patients are encouraged to consider their own privacy. The team have produced guidance for use of Skype in clinical care with support from their ICT department, using NHS guidance.
“There haven’t been many issues and the patients are mindful of the appropriate use of Skype,” Desiree said. “We wrote to all patients and asked them if they wanted to use Skype, then held some focus groups to understand why some patients had previously disengaged with the service but had embraced the use of Skype and what they told us was very interesting.
“It wasn’t just more convenient but being able to integrate diabetes care into normal every-day life, work and university, made it much easier to manage. They didn’t want their life being managed by clinical appointments but they can use Skype out and about with friends, at work or at university. It’s quick and easy; if they had a question before they could wait months to ask it at their next clinic but with Skype they can get an answer within hours.”
Skype is offered for patients who do not need a physical examination and is a choice by the patient. The service is offered by the specialist diabetes nurses and lead consultant for the Young Adult Service, who also respond to queries on the Skype message system in between appointments or after clinics.
Results indicate that further savings can been made through a reduction in DNAs, better health outcomes and associated decrease in A&E admissions, with increasing use. There have also been significant savings for patients (especially where this impacts on earnings) and wider societal benefits.
The Young Adult Diabetes Service at Newham has around 215 patients between 16 and 25 on its records. Attendance among these young people is flexible but patients are encouraged to attend at least three months a year. All patients with internet access are offered the option online contact via Skype.
Dr Shanti Vijayaraghavan, diabetes and endocrinology consultant at Newham University Hospital, said: “We are very pleased at the results we have had so far and I am increasingly offering it to all of the patients attending my diabetes clinic.
“It means we can keep in touch with a number of patients who might otherwise have become disengaged and present later with complications. While we understand there will always be a percentage of people who do not attend any type of appointment, we are keen to offer more flexible outpatient access which is better able to accommodate patient needs.
For more information on the pilot please contact Joanne Morris on: firstname.lastname@example.org