Proactive management of diabetes made possible with EMIS Web

Liverpool Diabetes Partnership (LDP) is cutting costs, improving outcomes and delivering better preventative care by running reports and conducting searches from within their clinical IT system.

It turns out that our clinical software and an innovative multidisciplinary service are the perfect combination for achieving better proactive care for patients with long-term conditions.

Formed by several trusts as part of the Healthy Liverpool Vision, the Liverpool Diabetes Partnership (LDP) is a service that’s dedicated to improving the treatment of diabetes. By making use of their clinical data with Search and Reports in EMIS Web, LDP is now proactively identifying and targeting those who are at risk of developing diabetes or whose condition isn’t being effectively managed.

“The audits allow us to keep patients safe, make sure that they’re on the right medication and make sure they’re being monitored.”

Collette Kelly, diabetes specialist nurse, Liverpool Diabetes Partnership

LDP’s multidisciplinary teams are subsequently working with GP practices to put together truly targeted packages of care for these patients. Doing so has had a transformative effect on how diabetes is managed throughout Merseyside: not only has it contributed to 50% fewer hospital appointments, but the service has lowered costs and improved clinical outcomes too.

Making effective use of clinical data in order to deliver targeted care

“A lot of what we do is with audits,” explains Collette Kelly, diabetes specialist nurse at LDP. “We’ll do a clinical session and see patients, and then we’ll pop on an audit or a search at the end. A good example from when we first started using Search and Reports is our search for hypoglycaemia with a low Hb1Ac. There were a lot of medication changes that came from that audit.

If a patient’s been on medicine that’s quite high in costs, or they’re injecting themselves with something that’s not working, we search for that too. We’ve also been looking at which patients have been on a medication for longer than 12 months that have an Hb1Ac that’s elevated. Then we can run through those patients and invite them into clinic to review their medications.”

“We’re actively searching for patients, not just waiting for them to come to us.”

Collette Kelly, diabetes specialist nurse, Liverpool Diabetes Partnership

Better management of diabetes isn’t just limited to those who are already known to have the condition already either. Since there’s a link between cardiovascular disease (CVD) and diabetes, the team is searching for patients with the former condition that they can bring in and proactively test. That way, LDP can get ahead of diabetes and deal with it before it becomes a bigger issue.

Reducing costs by optimising medicines and prescribing

With these medication reviews underway, the service is now able to really understand what medicines will work best for which patients and what medicines aren’t needed. It’s by providing this more tailored care that LDP has been able to reduce hospital admissions and improve outcomes.

“The benefits are two-fold because practices see the cost efficiency and clinicians see an improvement in the patient care.”

Jan Fennell-Rutherford, operations manager, Liverpool Diabetes Partnership

LDP has also found that these searches have helped them to reduce spend. “We do a lot of cost-saving work in primary care,” adds Collette. “We look at who’s been prescribed blood glucose testing stripes when they don’t need them, and who’s been given 100 needles a month when they only use one a day and they’ve got boxes piling up. We use the searches a lot in our primary clinics.”

Medicines represent the second largest spend in the NHS, while between 30-50% of medicines prescribed for long-term conditions are not taken as intended. Numbers like these lie behind NHS England and the Royal Pharmaceutical Society’s shared drive to improve medicines optimisation. Yet by using Search and Reports and analysing their clinical data, LDP is at the forefront of tackling these pressing issues.

So straightforward that staff can get up and running in no time

The ease of using Search and Reports has played a big part as to why LDP’s proactive care has become so successful. As Collette explains, “The running of reports is easy. I did the basic training and thought, ‘finding these patients is going to revolutionise my life in practice.’ I even signed up for the advanced training.”

“You know it’s easy if I can use it!”

Collette Kelly, diabetes specialist nurse, Liverpool Diabetes Partnership

Because of the module’s simplicity, LDP is now looking to expand their searches. “We’ve got two new staff who are going to look at cardiovascular patients because it’s so easy to write and run,” says Jan Fennell-Rutherford, operations manager at LDP. “They can go into practice and get that information and target that group.”

With growing capabilities to focus on even more patients, LDP’s transformative care is only going to make even more of a difference to how diabetes is treated and tackled throughout Merseyside.

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