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Assumptions used in estimating a population benchmark

The assumptions used in estimating a population benchmark of 0.23% per year (or 75% of people newly diagnosed with type 2 diabetes in a year) for new referrals to a structured patient education programme for people with type 2 diabetes are based on the following sources of information:

  • current practice on the detection rates of type 2 diabetes
  • published research on the current provision of education and training for people with diabetes
  • expert clinical opinionof the topic-specific advisory group, based on experience in clinical practice and literature review.

For the purpose of this commissioning guide the adult population has been defined as people aged 15 years and older. This definition is also used in the commissioning and benchmarking tool

Current practice

The IMS Disease Analyzer[1] is a database that holds data from a sample of GP practice systems, was used to assess the prevalence and incidence of diagnosed type 2 diabetes. Analysis of the data suggests that the prevalence of diagnosed type 2 diabetes in people aged 15 years and older is 4.72%. The diagnosed incidence of type 2 diabetes (the average detection rate of new cases in a year) is estimated to be 0.30% of the population aged 15 years and older .

The NICE Diabetes in adults quality standard produced the following quality statement on structured education programmes for people with diabetes:

NICE Quality Statement 1: People with diabetes and/or their carers receive a structured educational programme that fulfils the nationally agreed criteria from the time of diagnosis, with annual review and access to ongoing education.

DiabetesE, is a standardised, web-based, self- assessment quality improvement tool, which is complimentary to the national diabetes audit. The Seventh National DiabetesE Report[2] reported the following:

  • 85% of PCTs have contracts to provide NICE compliant education for people with newly diagnosed Type 2 diabetes, but only 66% review whether all people newly diagnosed are offered structured education.
  • 76% of PCTs' structured education programmes meet the key criteria set out in the Patient Education Working Group's report on Structured Education in Diabetes.
  • To ensure the quality and consistency of structured education programmes, in 61% of specialist services the programmes are assessed by independent assessors, and in 74% the outcomes from patient education are regularly audited.
  • Although structured education is offered to the majority of people newly diagnosed with diabetes, 48% of specialist providers report that structured education programmes do not have the capacity to meet demand.

Published research

The 2006 National survey of people with diabetes[3] included a section on education and training. We have assumed that the term ‘education and training course' used in the survey refers to a structured patient education programme as recommended by the NICE clinical guideline CG87 on type 2 diabetes - newer agents (a partial update of CG66). The survey found there was a wide variation in the proportion of people with diabetes who had been offered a structured patient education programme and in the proportion of people with diabetes who subsequently took up this offer:

  • around 17% of people with diagnosed type 1 and type 2 diabetes have been offered an opportunity to attend a structured patient education programme at some point in the past
  • around 60% of the 17% took up the offer and attended a structured patient education programme at some time.

This estimated 60% current take-up of structured patient education programmes is in line with analysis of data submitted as part of the National Diabetes Audit for the period 2005-2006. The audit suggests that, in areas with established structured patient education programmes, around 60% of people who have been diagnosed with diabetes for less than 1 year have attended one.

This means that 40% of people with diabetes that had been offered the opportunity to attend a structured patient education programme did not attend. Over two thirds of the reasons given for not attending were organizational or not liking group training (see table 1)

Table 1. Reasons for not attending a diabetes education or training course

Reason for not attending an education or training course when offered Percentage (rounded to the nearest percent)
I don't like group training 30
The time of day was inconvenient 27
Other reason 15
The location was inconvenient 12
No response 10
The course did not cater for my disability 3
The course was not suited to my cultural needs 2
There were no male only or female only courses 1

Assuming that many of the service delivery barriers in table 1 could be overcome, the take-up rate of structured patient education programmes for people with newly diagnosed type 2 diabetes could be increased significantly.

It has been assumed that the people in the survey[4] who are currently offered and attend an education or training course are representative of people with newly diagnosed type 2 diabetes generally (the survey did not distinguish between type 1 or type 2 diabetes).

Expert clinical opinion

The consensus of the topic-specific advisory group was that when people with diabetes are told that structured patient education programmes are an integral part of diabetes care, services are likely to achieve a 60-90% take-up of people newly diagnosed with type 2 diabetes. The range of benefits for patients described in Commissioning a patient education programme for people with type 2 diabetes should be emphasised. The programmes aim to improve people's health and confidence so that they can care for themselves, rather than simply increasing their knowledge.

Conclusions

Based on the epidemiological data and other information outlined above, it is concluded that the benchmark for new referrals for structured patient education programme is 0.23%. This is based on the following assumptions:

  • the incidence of diagnosed type 2 diabetes is estimated to be 0.3% of the population aged 15 years and older
  • the midpoint of the estimates (60% and 90%) on the potential take-up of a structured patient education programme is 75%.

Therefore the population benchmark for new referrals to a structured patient education programme is estimated to be 0.23% of the population aged 15 years or over.

Use the patient education programme for people with type 2 diabetes commissioning and benchmarking tool to determine the level of service that might be needed locally and to calculate the cost of commissioning the service using the indicative benchmark and/or your own local data.

Commissioners should use their local needs assessment to determine optimum levels for local service provision. Commissioners should note that the benchmark rates do not represent NICE's view of desirable, or maximum or minimum, service levels.

Commissioners should use this benchmark and local data to facilitate local discussion on optimum service levels. There is considerable variation in the number of people with diabetes. This is influenced by the social, economic and demographic profile of the local population, therefore commissioners are encouraged to consider local assumptions



[1] IMS collects data from a sample of GP practice systems. Around 100 are currently delivering data and the database has about 2.7 million patient records. The sample includes practices from England, Wales, Scotland and Northern Ireland and has a representative UK sample by age and sex. The database holds significant clinical events relating to any period in a patient's life where summarised into computer records by the practice. As in any observational database, data entered by panel doctors may be incomplete.

[2] SEVENTH NATIONAL REPORT: EXECUTIVE SUMMARY, Dibetese E, January 2012

[3] The views of people with diabetes, Key findings from the 2006 survey, healthcare commission, 2007, London.

[4] The views of people with diabetes, Key findings from the 2006 survey, healthcare commission, 2007, London.

This page was last updated: 03 April 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.