Diabetes intervention worker project aims to overcome inequality in access to diabetes technologies
Role of diabetes information worker created to understand and address barriers to technology.
When Somerset NHS Foundation Trust realised there was a significant inequality in access to diabetes technologies – both insulin pumps and real-time continuous glucose monitors (rtCGM) – they created a new role to address the issue.
The Trust recently received the Quality in Care (QiC) Diabetes award in the Equality, Diversity and Health Equalities category.
In many cases these inequalities were found to be as a result of socioeconomic deprivation – scored using the Index of Multiple Deprivation (IMD) quintiles.
The ‘diabetes intervention worker’ (DIW) role was piloted, seconded from the Family Intervention Service (FIS), to improve understanding and address barriers to technology.
Interventions included direct work with young people and families, provision of mobile phones, laptops and SIM cards, plus team focus on promoting technologies to all patient groups.
These actions resulted in a significant increase in pump and rtCGM use in the most, and second most, deprived areas.
In addition, there was a reported resolution of inequality in technology use, plus a corresponding reduction in median HbA1c (blood glucose levels).
The one-year, NHS England-funded project employed a new staff member in a pilot DIW role, who was dual trained in diabetes technologies and family intervention work.
The aims were for children and young people with diabetes in the most and second most deprived areas to achieve the same use of diabetes technologies as average levels.
The service aimed to learn more about working effectively with families experiencing deprivation. Support was offered in patients’ homes or close to home, via telephone or video.
A case study on the project from QiC Diabetes reported that there was a holistic approach to the work, supporting families with social needs before focusing on new technologies.
Patients in deprived areas were identified by their postcodes and prioritised according to current use of technology and HbA1c as a clinical outcome measure.
Initially the focus was on improving use of a dose calculation app, providing more real-time CGM devices (rtCGM) and insulin pump therapy. Local funding changes shifted focus to delivering more pump upgrades to hybrid closed loop (HCL) options and HCL starts. Use of rtCGM, insulin pumps and HCL systems was recorded. HbA1c was recorded at the start and end of the project. The DIW kept records to help understand common themes.
The case study said: “Some families had low awareness of the technology options available. Teaching in their own homes was effective. Another issue was lack of compatible devices (eg. mobile phone/computer) and costs of data, even where a phone could be provided. The DIW secured charitable donations of 30 rtCGM-compatible mobile phones and five laptops, and 50 free data SIM cards came from a national mobile phone company.
Some families thought they had to access training online, or travel (with associated costs). Here, education and training in patients’ homes helped. Where online training was essential, the DIW sat alongside patients to build confidence. Some patients needed transport to clinics or technology starts. Some young people anxious about wearable technology were helped by relationship building, home demonstrations and in-person support for the first sensor changes.
The DIW worked flexible hours to support families where necessary and shared patients’ difficulties with other professionals. Most support was needed with direct, practical help using diabetes technologies. Much of the work could be delivered at lower cost by a band 4 health care assistant trained in diabetes technologies.
Following an overall increase in use of technologies, the Trust extended the project for three months.
The results have been presented to the two children and young people with diabetes teams in the Trust, the Integrated Care Board, a local Health Inequalities Board meeting, plus regional teams at the South West Children and Young People’s Diabetes Network meeting.
A statement from QiC Diabetes on the project said: “The project showed that there were significant benefits to be gained from a dedicated practitioner offering holistic care, and that there is a case for embedding key areas of learning into local practice. The intention is to review the feasibility of future team roles with flexible hours and increase face-to- face outreach options in service delivery. IMD quintiles will be included in quarterly reviews of data on HbA1c and technology uptake and noted for each patient when planning support.
“There is an ongoing need for sustainable sources of allied technologies. It would be relatively straightforward for another service to implement a similar initiative, using a healthcare worker with similar remit, or an allied worker with a social care background.”
DRWF are proud to support the QiC Diabetes Awards.
Find out more about Quality in Care Diabetes awards
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