Non-physician's ‘key’ to combating type 2 diabetes therapeutic inertia
Pharmacists, nurses and educators ‘key’ to combating type 2 diabetes therapeutic inertia
The EDEN team were very encouraged by the recent publication of the first systematic review on overcoming therapeutic inertia, published by the Diabetes, Obesity and Metabolism journal; the results were simultaneously shared at the ADA’s virtual 81st Scientific Sessions.
The report reviewed 36 articles and confirmed EDEN’s independent analysis and research: “The most effective approaches to mitigating therapeutic inertia and improving HbA1c were those that empower non-physician providers such as pharmacists, nurses and diabetes educators to initiate and intensify treatment independently, supported by appropriate guidelines.”
The term “therapeutic inertia” refers to the failure of the healthcare provider to initiate therapy, advance therapy, and/or de-intensify therapy when therapeutic goals are not reached.
The review found that successful medication management led by pharmacists or nurses was enhanced by their ability to independently initiate and intensify treatment, as long as they were supported by the appropriate guidelines.
The review concluded that all of the nurse- and pharmacist-led interventions were effective at reducing HbA1c.
EDEN began to realise the full potential of clinical pharmacists in caring for people living with diabetes in 2018, when they began to include them in EDEN diabetes training, developing bespoke training and mentoring to specifically suit their needs.
EDEN launched its successful pilot study in 2018. A clinical pharmacist was trained in diabetes management in primary care through a blended learning approach of study sessions, eLearning modules and clinic mentoring over a six-month period. Analysis of patient data from 30 patients living with diabetes, cared for by the pilot pharmacist, showed significant reductions in HbA1c, blood pressure and cholesterol. The patients also stated in their feedback that the pharmacist was their clinician of choice when it came to their diabetes care. As a result of this, EDEN’s COMPLEMENT programme was developed.
To ensure equity of access, regardless of geography, responding to national demand and in response to the Coronavirus pandemic restrictions, EDEN developed COMPLEMENT PLUS, which was launched in June 2020.
COMPLEMENT PLUS is a fully virtual diabetes training programme for clinical pharmacists and comprises: four recorded lessons, four eLearning modules and four mentoring sessions over a maximum of twenty weeks. The course emphasises the importance of avoiding clinical inertia, and shows how life threatening or debilitating complications can be avoided or postponed by progressing with the right treatments, or withdrawing treatments, for that patient in a timely manner.
Based on feedback from the pharmacists who have gone through the COMPLEMENT programme to date, the mentoring was the most valuable element. This is where case studies are discussed and learning is embedded into ‘real life’ situations and it confirmed that this element remains an integral and unique part of all EDEN training.
We have received a number of similar requests for a programme for practice nurses and have conducted a practice nurse pilot study. Following its success, we are excited to announce the launch of COMPLEMENT PLUS for Practice Nurses this September 2021.
Feedback from our COMPLEMENT PLUS for Practice Nurses pilot:
“I have recently been involved in the complement plus diabetes e-learning and mentorship programme. I had been seeking some learning that might validate my diabetes role and help with prescribing for diabetes once I have completed my non-medical prescribing course. The e-learning and video sessions have been a fantastic resource and have signposted me to lots of useful documents and information. I have been encouraged to reflect on the learning which has allowed me to get the most out of my mentorship sessions. The mentorship has provided an opportunity to ask any questions and for case reviews. I am much more confident in my ability to intensify treatment, step down where appropriate and titrate effectively and safely. I feel really lucky that I have had the opportunity to do this and would definitely recommend the course to other practice nurses.”
Professor Kamlesh Khunti, who led the first systematic review on overcoming therapeutic inertia and is Co-Director of the Leicester Diabetes Centre, Director of NIHR ARC East Midlands and Professor of Primary Care Diabetes and Vascular Medicine at the University of Leicester, said:
“It is encouraging to see the steps that EDEN have made with providing essential education, specifically aimed at pharmacists and practice nurses to support non-physician healthcare professionals to initiate and intensify treatment independently. I am looking forward to hearing the outcomes of the latest COMPLEMENT PLUS for Practice Nurses programme”.
EDEN are proud to be supporting healthcare professionals to address the global problem of therapeutic inertia, where the benefits of providing training and giving ongoing support to healthcare professionals are directly passed on to people living with diabetes. With COMPLEMENT PLUS, as with all we do in EDEN, our ultimate goal is to prevent complications where possible and optimise quality of life for all people living with diabetes.
Written by Fiona Munday, lead for COMPLEMENT PLUS, EDEN.
Fiona is an Education and Research Associate, delivering study sessions and mentorship as a Diabetes Educator to Healthcare Professionals locally and nationally.
If you would like to find out more about COMPLEMENT PLUS, please complete the form below and click submit.