Dear Colleagues,
As you will know we have been arranging details to look at the issue of
identifying patients at risk of developing Diabetes. Our view is that whilst
management of diabetics is vital, if we are to manage the impending “epidemic”
of diabetes and obesity related diseases, we need to intervene earlier. Hence this
project, and having discussed with the CCG and PH, we anticipate this will be
cost neutral for practices.
This letter is a request for commitment to the project and comprises a bit more
information, as well as collecting some practice details, and asking for your sign
up to the details. We hope you have already had some outline discussions and
with the information included here, will be prepared to make a firm decision.
Please complete and sign this form and return to Dr Tim Walter, Falkland
Surgery by mail or fax (01635 279973) even if your response is to not
participate.
I’ve tried to balance clarity with simplicity and broken down the project
description into sections but please contact me if I’ve made any blinding errors…
BW Tim Walter
Please complete this page and return to Dr Walter
Information collection, NADCC Pre Diabetes Project
Surgery Name –
Practice Manager or Authorised contact name –
Clinical Record System –
Emis CDB (if Emis) -
If Emis
Date of conversion to EmisWEB –
Are you already signed up to QResearch –
If not would you wish to be –
Do you wish to participate in the PreDM Project –
If Yes
Do you want Project staff to perform your searches for you?
Do you wish to perform your searches yourselves?
We are aiming to provide both surgery-based, and location-based E4H sessions
Do you wish to have surgery-based sessions for your patients Are you able/willing to host sessions for fellow practices –
If location based how far will your patients travel Do you have an “earliest start date” –
I consent to the QDiabetes calculation being performed on the practice
population, and 50 patients being selected for invitation to the E4H sessions.
Anonymised data will be extracted to support analysis and identifiable data to
support clinical care. See attached details.
Signed –
Date –
Lead GP name –
Assessment of Diabetic Risk
Many of you will be familiar with QRisk (which is a UK version of Framingham
IHD Score) produced by QResearch in Nottingham.
QDiabetes works on a similar basis but calculates a prediction for developing
Diabetes Mellitus over the next 10 years. It can be run for an individual or in this
case across a GP population.
By running the calculation (see below) we can then identify those patients at
highest risk. We will then identify the characteristics of those in each risk group,
e.g. BMI, Age, co-morbidities etc.
We then intend to identify those patients at highest risk and offer further
assessment and intervention as described below.
For current or future EmisWEB practices
QDiabetes can be run across your practice population within EmisWEB to
identify those at increased risk (in general >20%)
For Emis LV practices not planning EmisWEB yet
If you are a member of the QResearch research database we can run QDiabetes
centrally (in Nottingham) for all those practices.
For other practices
We can extract data to MS excel from you system and run the calculation on this
dataset to identify a similar target group.
NB QResearch is a GP record database held in Nottingham in conjunction with
Emis and the University of Nottingham. Signup is free for Emis Practices and can
be arranged easily if you wish. It would make life very much easier for us if all
Emis Practices considered signing up, but is not obligatory.
http://www.QResearch.org
http://www.Qdiabetes.org
Search Parameters and data extraction
QDiabetes can be used in any patient aged 25-84 without existing diagnosis of
type 2 diabetes
For the calculation it uses
Age,
Gender,
Ethnicity,
Postcode,
Smoking Status,
FH of Diabetes,
H/O of vascular disease,
BP on Treatment,
Steroid Use,
BMI
This will allow calculation of a Diabetic Risk score and a list of those at highest
risk to be generated so that they can be contacted.
We would also like to characterize the patients in terms of co-morbidities. Once
this data is made available no identifiable data needs to leave the practice. (The
strongest identifier is the postcode, which would not be needed any further.)
Outputs
For each participating practice the 50 patients at highest risk will be identified
and a standard invitation letter sent to them. (See below)
Each participating practice will be provided with a summary of the risk scores
grouping across the population, and comparative data.
Global data analysis (summary data only) will be published with a view to
enabling other CCGs to understand and emulate the process.
Patient Invitation
For the 50 patients identified for each practice, we will write a standardized
letter of invitation to participate in the study/intervention.
Experience from Falkland Surgery suggests that about half of patients will
respond and about a third will participate and complete the course.
The invitation letter will




Inform them of their risks (and benefit of action)
Invite them to a “taster” E4H session
Invite them to have baseline blood tests
Invite them to complete a lifestyle questionnaire (t.b.c. by Public Health)
The invitation will give them a contact number for E4H to arrange attendance at
the taster session, so although a few may contact the practice directly for either
practical questions or health related questions we don’t expect this to be
significant (and wasn’t at Falkland Surgery trial)
At the taster session the E4H organiser will verify that the blood tests are
arranged, the questionnaires distributed and completed prior to entering E4H
sessions proper.
Practice Timeline
Complete this information/consent form ASAP (within 2 weeks of receipt please)
Thereafter a start date will be agreed (According to practice wish and E$H
staffing etc)
First 2 w - Initial searches performed and target group identified
2 w – invitation letters sent out
4 w – E4H taster session
6 w – All Questionnaires and blood tests completed
6 w – E4H sessions started and BMI, waist etc. readings taken
16 w – E4H finishes and body measurements repeated, optionally repeated
bloods offered.
20 w onwards – Final data collection to include repeat bloods and BMI etc.
Practice Commitment
Allow or facilitate data extraction as described
Mailing of pre-printed invitation letters
Receipt of blood tests and action of any significant abnormals (however there
will be an E4H intervention planned so initial action may not be needed except in
severe anomalies) (approx. 20-25 results per practice)
Hosting of E4H sessions if agreed
Data entry of collected data (BMI Waist etc.) into your own clinical systems
Consideration of “exit” blood tests as needed
We anticipate that for each practice we might identify one new diabetic, and one
patient with IGT, which obviously will need to be dealt with appropriately.
Financial considerations
This project is intended to be cost neutral for practices.
I’ve identified the funding of each stage and in brackets the anticipated numbers
of patients per surgery.
QDiabetes Search and risk scoring. (FOC or practice time if you choose)
Letter printing (50) Practice
Letter mailing (50) CCG reimbursement
Blood Tests (25) CCG
Blood Test interpretation (25) Practice time
E4H Taster and E4H course (15) CCG/PH
E4H session hosting (15) CCG reimbursement if at surgery location
Questionnaires and data interpretation (25) Research Grant
Positives financial impact for practices
Please note that by using QDiabetes we have identified patients at high risk so
these patients generally will be suitable for inclusion in the Weight
Management LES and if they complete the E4H course you might like to
consider recording them on the register and adding appropriate read codes.
They may also fulfill IHD Primary Prevention LES criteria and since they will
have appropriate screening lipid levels and advice some may be claimable for
this LES as well.
E4H will also record and share data for smoking and BMI which can also help
your QOF data in a small way.
We therefore hope that in purely financial terms this will not only be cost
neutral, but potentially have some positive aspects.