Step 1. Consider “WHY” change prescribing

Type 2 diabetes mellitus: Quality prescribing strategy - a guide for improvement
Scottish Government Effective Prescribing & Therapeutics Division
Polypharmacy icon of two pills

Consider “WHY” change prescribing

Create a sense of urgency - consider the impact of Type 2 diabetes locally, using local and national data, related to new guidance. Both long and short term outcomes need to be managed and reduced.

 

Suggested actions

 

 

Incidence of T2DM

Consider the incidence and prevalence locally, at board, cluster and practice level. Does this vary with national and other local data?

 

Cost of managing T2DM

The population is aging and living longer, with earlier onset T2DM.

Consider the cost of diabetes to the individual and the board in managing these – personally, financially and resource involved?

 

Target glycaemic control (HbA1c)

  • Review current management strategies and population treated to target HbA1c range.

 

Reducing/preventing long-term complications/co-morbidities

  • Newer therapies reduce adverse clinical outcomes such as cardiovascular disease and kidney disease.
  • Consider if these therapies are being prescribed where appropriate.

 

Identify “WHO” can support prescribing change

Suggested actions

 

 

Specialism

  • Diabetologists
  • Endocrinologists
  • Managed Care Network
  • MCN manager
  • Diabetes specialist nurses
  • Clinic managers

 

Hospital/acute location

  • Care of Elderly/Medicine for Elderly wards and staff
  • Renal
  • Acute admissions
  • Pharmacy department
  • Dietetics

 

Primary care/GP practice

  • Cluster/practice quality leads
  • Clinical lead (in GP practice for diabetes)
  • ANPs, long-term condition nurses
  • Healthcare assistants
  • Reception staff/Practice/office manager
  • Pharmacist/technician

 

Create and communicate a clear vision 

  • Explain the benefits of changing prescribing in T2DM – better type 2 diabetes control, less complications and co-morbidities, potentially less medication usage, lower environmental impact
  • Acknowledge the challenges – resistance to change, polypharmacy should be appropriate, patient/clinician perception of ‘good control’
  • Developing a communication and engagement plan will help ensure stakeholders across your service are kept informed and involved as you make changes

 

Consider how you will engage with wider stakeholder networks

Patient groups, Council and community groups (e.g. physical activity groups), Community link workers and third sector agencies, Local Formulary Groups, wider MDT (Opticians, Podiatry teams etc).

 

 

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