Minutes National Diabetes Leadership Group – Implementing Living Well with Diabetes Date: Tuesday 13 March 2018 Time: 09:30am – 3:30pm Location: Room G.C3, Ministry of Health, 133 Molesworth Street, Wellington Chair: Paul Drury Attendees: Wing Cheuk Chan, Laila Cooper, Bryan Betty, Andrea Rooderkerk, Jeremy Krebs, Charlotte Harris, Sian Burgess, Deb Connor, Catherine Gerard (for item 5), Catherine Lofthouse (note-taker) Apologies: Nicola Ehau Item 1 Notes Welcome and conflicts of interest register: The conflicts of interest register was shared with the group and updated. An electronic copy is provided with these minutes. Action: MoH to circulate list of conflicts 2 Review of minutes and action points from previous meeting Minutes from the previous meeting were accepted, subject to the amendment below: Item 5: roundtable update from all members. The review of community diabetes nurse and dietetic services is being conducted by Canterbury Clinical Network and Canterbury DHB, rather than Christchurch PHO as previously reported. The following action items were discussed and noted: 2016/23, 2017/19 – CVD consensus Consensus statement has been published. There remains a question of how this gets implemented as no agreement on how it will be socialised and incorporated into PMSs. Implementation is likely to be cloud-based. 2017/11 – Inpatients 1 Some DHBs have shown improvement, others not. Data shows there has not been a drop-off in diabetes admissions. Paul also noted that integration of inpatient care and subsequent follow-up elsewhere remains an issue. 2017/13, 2017/20 – Lab data Paul has discussed this with Andy Simpson and will talk with Peter Jones (MoH). Things are not progressing quickly, although there is wide support for this idea. Wing noted that Trevor English may be interested in looking into diabetes data, using ICNet.` 2017/14 – BPAC article on young adult diabetes Paul noted that this is progressing. 2017/16 – Tairawhiti DHB The Ministry team plans to visit Tairawhiti DHB in April 2018. Also noted that the team hope to visit the remaining four DHBs and to revisit the largest six DHBs this year. 2017/23 – Progression from pre-diabetes Two issues were raised: (1) resource is not being prioritised; (2) lack of differentiation between high risk groups and non-high risk groups. Also noted that education is still needed for providers. At PHO level there is a generic approach to managing diabetes, ‘a tick-box mentality’ to doing checks. 2017/24 – Healthier Lives National Science Challenge This is at the half-way point, and is being reviewed to elicit feedback on the direction it is heading and whether it is meeting needs. MBIE will use feedback to inform the next tranche of funding. Action: Jeremy to provide further update at next meeting. 2017/25 – Pharmac data queries The MoH team met with Bryan and Jason in February. Pharmac is focused on equity and access to medication, now beginning to look into diabetes in this regard. A Metformin project is in process. 2017/26 – Pharmacy presentation at NZSSD Not actioned. Will put onto agenda for 2019 NZSSD conference. 3 Ministry and round table update Catherine provided an update on Ministry progress since October. The group provided comments and advice on the following projects:  Identifying support needs for young people with type 1 diabetes. Variation of services nationwide is an issue. Also, the age of service transition varies across the country. We should not lose sight of young people with type 2. In addition, Diabetes NZ are doing some work looking at the gaps in services. A stocktake of services was also recently completed in Auckland. Charlotte will share report if and when able. Actions: MoH provide update on the young people with type 1 project at next meeting Charlotte to share report on stocktake of services (if and when available) 2   Weight management support in primary practice There should be less emphasis on ‘weight’, more on healthy lifestyle factors. Monitoring weight trajectory is advised. SMS4BG It would be good to do a long term follow-up. Paul reported some concern that this project doesn’t measure robust clinical outcomes. However, a potential benefit of this project would be increased trust in the provider, which improves engagement with the health service. Action: MoH share project reports for SMS4BG and psychology support for young people with diabetes Other NZSSD and Diabetes NZ are forming a joint advocacy steering group. They will be working to ensure messaging is consistent between consumers and clinicians. This combined group could put in application to Pharmac for Freestyle Libre. Diabetes NZ would be willing to provide centralised repository of resources. They are currently developing resources on diet and on psychology support. 4 Future vision for diabetes workshop Prem Kumar HQSC observed the group brainstorming ideas on planning quality improvements for diabetes care and services in New Zealand by teleconference. Medium term (until end of 2020) and long-term (beyond 2020) actions were considered. The main themes emerging were:          5 Workforce education, especially GPs and nurses, and not just primary care. Improve health literacy and education for consumers, such as DSME, centralised repository of information. Inconsistent access to services nationwide (eg, rural vs urban). Disconnected service delivery across primary, secondary, allied health and community care. Use of technology. Incompatible IT systems. Consistency with Triple Aim Barriers to care Consistent key messages-suggestion that all group members develop 5 priority key messages that can be incorporated into Diabetes Awareness month and other communications. DHB and PHO performance Catherine shared images of the upcoming update of the Atlas of Healthcare Variation. This should be available to coincide with the new VDR (estimated April 2018). The new version will allow more variation in what data is shown and how it is presented. HQSC have also been working on practice-level analyses. The new version of the Atlas needs to be socialised to encourage uptake. 6 Data discussion Wing’s prediabetes data will be publishable when the 3-year data is available. VDR for the year ending 20** will be available in ****. MoH have run the provisional data. This shows a slight increase in total prevalence but not in the WHO corrected population or when adjusted for NZ population increase. This data is yet to be finalised and is not for release at the moment. 3 There has been some exploratory work into a VDR for type 1. The paediatric network were positioned to provide data for children with type 1. Yet to decide how to obtain data for the young adult group. Hospitalisations data is not showing any improvement. Amputations and renal replacement therapy suggestive of some improvement. Major amputations trending down, minor amputations trending up, overall amputations stable. 7 Next meeting Tuesday 31 July 2018 4 Item 2016/23 2016/25 2016/35 2017/01 2017/04 2017/11 2017/13 2017/14 2017/16 2017/18 2017/19 2017/20 2017/21 2017/22 2017/23 Action Keep the group updated on progress towards updating the CVD risk consensus statement Arrange for updates on the Compass Health and Northland/Tairawhiti projects at the next meeting Discuss new technology for type 1, via email Share pump-related codes with Paul Ask Tofa and Sera if they are interested in supporting the NDLG Inpatients – - summarise key issues - assemble group to discuss need for standardised care in hospitals - add item to agenda for meeting with DHB CEs, and for meeting with nurses Availability of lab test data - list people to seek endorsement from - follow-up with Andy Simpson Prepare a memo to clinical leads on early onset diabetes Talk about MoH support for Tairawhiti DHB Invite Fran or Craig to present an update on children and young people at NDLG meeting May 2018 Talk to CVD consensus group about concerns Availability of lab test data: - Make enquiries with lab test providers - Talk with Andy Simpson Explore options for a centralised repository of diabetes resources Send Dr Tom and Allen + Clarke reports to the group Summarise the findings and recommendations from the work on risk of progression from pre-diabetes to diabetes Lead MoH team Due Date Ongoing Status Closed Mar 2018 MoH February 2017 Closed Mar 2018 Diabetes Leadership Group Bryan Ongoing May 2017 Ongoing MoH May 2017 Ongoing Paul/MoH/NDLG May 2017 Paul/MoH Still to progress MoH October 2017 Ongoing Wing, Paul Paul NDLG October 2017 Ongoing Paul, Nicola Paul/MoH October 2017 Closed Oct 2017 May 2018 Ongoing Paul Mar 2018 Mar 2018 Closed Mar 2018 Ongoing Paul MoH Mar 2018 Ongoing MoH With minutes Paul Mar 2018 Closed Mar 2018 Closed Mar 2018 Sian 5 2017/24 Share Healthier Lives National Science Challenge mission statement with the group 2017/25 Forward specific Pharmac data queries to Sian 2017/26 Talk with NZSSD about a pharmacy presentation at the 2018 conference 2018/01 Circulate conflicts of interest list 2018/02 Provide update on Healthier Lives National Science Challenge 2018/03 Provide update on young people with type 1 project 2018/04 Share report on stocktake of services 2018/05 Share reports on SMS4BG and psychology support for young people Jeremy Mar 2018 Closed Mar 2018 All NDLG Dec 2017 Paul Mar 2018 Closed Mar 2018 Closed Mar 2018 MoH With minutes Jeremy July 2018 MoH July 2018 Charlotte When available With minutes MoH 6