Amir Hannan, Ed Jude, Jean Eades, Richard Fitton, Quesir Mahmood

Identified our patient population and their management to date

Identified staff’s confidence with managing diabetes and potential interest

5 sessions Each session to last an hour Health passports to be produced Folders for patients to help them look after

their own health ICP also happening that the practice is a part

of

Who are we going to target ? Severe complex patients at high risk of an

event Patients with impaired glucose tolerance

Create a patient-centred programme for…. Develop an internet resource to support

the programme Review some of the material we have

collected Care plans or…other more acceptable Intranet for staff Internet for patients and families Health Passport for staff Research paper to describe what we do

When do we want / need to start What help is there

From pharma company From Ed Jude From Amir From jean Eades (From Richard Fitton)

What are we going to do Who is going to do it Next steps? Next meeting

Each session lasts about 1 hour 30 mins

1st session (Ed Jude)Who are youWhat is diabetesHow many people can check their BP, weight, BMsWhat knowledge have they got alreadyCompliance and concordanceWhat are the targets we should achieveAre we asking the right questionsBring your own machine

2nd session (Richard Fitton)What is wellness and health, illness, fitness, disease and deathPrevention, managing diabetes, reduce risk of complicationsHeart attacks, blindness, kidney disease, neuropathy, stroke, PVDDescribing where you want to be 10, 20 or 30 years from now and then plotting how to get there

3rd Session (Jean Eades)Lifestyle changes – what is it, what is available and costs nothing, PCT health improvement plans and help available, walking buses, getting off bus 1 stop early, parking car further awayLocal sports activities, clubs etcdietary advice, smoking, alcohol, drugs, getting the best from clinicians to help achieve these goals (doctors, nurses, pharmacists, podiatrists, others including extended family, friends,

colleagues)

4th session (Amir Hannan)Information is power, records, records access, role of IT to support lifestyle changes and monitor own healthWhat tools are needed to support lifestyle changes, improve concordance and get the best from your healthcareultimately help shape a healthier lifestyle,

5th session (All of us)What was good, what was bad, do you want to know more about anything that we talked about or go over things that you would like to be remindedPresenting the data patients have measured and what they have achieved over the 5 monthsWhat are the next steps now and how to encourage others to start the programme

Need to ask patients to do something alone and do something together, Assessments (key pad) give people tasks to doPre-confidence knowledge, skills and attitudes and then repeat post course

Give the programme a “name” Need a “Mission Statement” Determine aims and objectives and results Determine knowledge, skills, attitudes, practice and experience Pre-consultation validated test and then post test Each speaker to produce what they plan to do / raise, research to find

out what they are going to do Determine what patients should do before the session, during the

session and afterwards Produce a care plan with pictures for patients and showing what their

targets should be Consider differences between IGT group and Diabetes group Patient passport needs to be developed Intranet website with information for staff (consider for patients too) Determine monthly appointments starting in 3 months time Need to determine date of next meeting and one more prior to

starting the session