Swansea UniversityStudy helps Digital Healthcare Deliver for People Living with Diabetes

A pilot service-evaluation study, undertaken by Swansea University, has shown that watching short health information films online helps people living with type 2 diabetes reduce their HbA1c – an established marker of diabetes control.

The report, to be published in the May issue of the international journal Primary Care Diabetes, shows a clinically significant improvement in HbA1c among those patients who watched one or more of the PocketMedic ‘Living with diabetes’ films on their computer, tablet or smartphone.

The film-watching was associated with a mean difference in HbA1c of minus 9.0mmol/mol. A strong correlation was observed between the number of films watched and the reduction in HbA1c. Significantly, no reduction in HbA1c was observed in the non-watchers.

Swansea University’s Professor Jeffrey W Stephens, consultant physician at Abertawe Bro Morgannwg University Health Boards’ Morriston Hospital and one of the report authors, said, “The result of this service evaluation is highly encouraging. The overall improvement in HbA1c indicates that film-watchers are more informed, motivated and committed to change their behaviour.” 

The anonymised study was undertaken by Swansea University’s Medical School in collaboration with Abertawe Bro Morgannwg University Health Board, Cardiff and Vale University Health Board, Hywel Dda University Health Board and supported by the Diabetes UK Clinical Champions programme. Each partner organisation supports the need for further research into the potential of internet-based educational prescribing.

During the study, there were eleven films in the PocketMedic ‘Living with diabetes’ series including: What is diabetes? What can I eat? Diabetes and weight, Looking after your feet, Stopping smoking, Medication and monitoring, Jill’s story, Jeff’s story and Tony and Michelle’s story.

Two Primary Care practices, within Abertawe Bro Morgannwg University Health Board and Hywel Dda University Health Board, identified 68 patients newly diagnosed with type 2 diabetes.

During a consultation with the practice nurse, each patient was ‘prescribed’ film-watching - by way of example see www.medic.video/diabetes - alongside standard treatments. The nurse talked through the nature of the PocketMedic films and explained that a routine blood test would be repeated after a 3-month period to monitor health outcomes.

Swansea University’s Dr Sam Rice, a consultant physician at Hywel Dda University Health Boards’ Prince Philip Hospital and one of the report authors, explained, “Digital prescriptions encourage people to access expert health information, practical advice and emotional support from the comfort of their own home. Each motivational film can be watched by patients and carers as many times as required and, crucially, at a time when the individual faces a new health challenge.”

The study shows that 1 in 4 (28%) people watched at least one film within 3 months of being ‘prescribed’ the film-watching. This level of uptake compares favourably with highly-regarded and structured educational programmes; where studies show attendance can be as low as 1 in 100 patients.

Dr Rice added, “With patient self-management widely recognised as an increasingly important treatment it is encouraging to see that this low cost and scalable solution is reaching many more patients than would otherwise be the case.

“Through further research, we may even find that the success of the film-watching becomes a stepping-stone to facilitate and encourage people living with a chronic disease to attend more structured educational programmes.”

The bite-sized, self-management films were produced by eHealth Digital Media in partnership with the report authors, Professor Stephens and Dr Rice. Each film was reviewed by expert patients, clinicians and frontline healthcare professionals before distribution. 

Kimberley Littlemore, co-founder and creative director of eHealth Digital Media and honorary fellow at Swansea University Medical School, said, “With a growing number of people living with a long term chronic condition, the PocketMedic films provide a simple and cost-effective way of helping people become more expert in managing their health.”

The relaxed and homely approach is designed to encourage people to become aware of symptoms, understand causes and recognise risks. The highly visual and engaging content features high-quality health information from clinicians alongside the personal and real-life experiences of people living with diabetes or other chronic disease.

Today, the PocketMedic library boasts around 100 films covering chronic pain, chronic lung disease (COPD), diabetes (type 1, type 2, gestational and pre-diabetes), heart failure, lymphoedema, life after cancer, wellbeing (anxiety and depression), and more. 

Joanna Lewis, co-founder and commercial director of eHealth Digital Media, said, “This is an exciting time for the PocketMedic team. We’re talking with many CCGs about the potential benefits of film-based prescribing and we’re on track to roll-out the service, across the UK, by 2020!

“We’ve signed-up GP clusters and NHS Foundation Trusts, including Hampshire and Bath.  We’ve received Welsh Government health innovation funding to allow all NHS Wales’ patients to access the ‘Living with diabetes’ and ‘Living with lymphoedema’ film series. And we’re re-investing the small income we’ve generated to extend the PocketMedic library in line with the health priorities of our NHS colleagues.” 

Through being better informed, people learn to make small adjustments that, potentially, help prevent health complications associated with their condition.

Professor Stephens concluded, “This small-scale but real-world study suggests that the prescription of an online health information film, alongside standard treatment, can afford significant benefits to the growing number of people who live with one or more chronic condition.”

Tony and Michelle Chelley share their experience of living with type 2 diabetes. 

Tony and MIchelle Chelley

Tony Chelley - Following an injury, more than a decade ago, Tony was diagnosed with type 2 diabetes. He struggled to accept the diagnosis – as he didn’t have any symptoms - and continued to eat large portions of his favourite foods. His blood glucose was out of control, the disease progressed and Tony was prescribed insulin. Having learned as a child ‘to eat everything on your plate’, Tony still finds it difficult to eat smaller portions of more healthy food. But, having lost more than 6 stone, Tony has a positive attitude to weight loss: “You’ll have good days and bad days but one bad day doesn’t mean you’ve blown it!” 

Michelle Chelley - Michelle was suffering from bad headaches. She decided to visit her family doctor and was shocked to find that, like her husband, she had developed type 2 diabetes. She decided to take decisive action and attended X-PERT - a structured educational course designed to encourage people to share knowledge and make the necessary changes to their diet and lifestyle. Michelle is enjoying a more active life. She has lost 4 stone in weight and regularly visits the gym with her daughter. Her advice? “Don’t panic! Diabetes isn’t the end of the world.”

  • Jeffrey W Stephens is Professor of Medicine (Diabetes & Metabolism) at Swansea University’s Institute of Life Sciences, Consultant Physician and Endocrinologist at Morriston Hospital, Member of the Council of Healthcare Professionals for Diabetes UK and Assistant Medical Director for Research and Development within the Abertawe Bro Morgannwg University (ABMU) Health Board.
  • Dr Sam Rice is a Senior Lecturer at Swansea University and an Honorary Fellow at Aberystwyth University. He is a Consultant Physician and Endocrinologist at Prince Philip Hospital, Deputy Research and Development Director at Hywel Dda University Health Board and one of 20 Clinical Champions selected by Diabetes UK to advocate for people with diabetes. Dr Rice has worked with commissioners, service managers and front-line healthcare professionals to introduce new methods of educating patients and sharing good practice.
  • Swansea University Medical School, established in 2004, is an internationally-recognised centre of excellence in medical research, education and innovation.  The Medical School has three main activities: learning and teaching, research, and business and innovation. Read about the history of the Medical School at http://www.scribd.com/doc/235047725/History-in-the-Making-College-of-Medicine-Swansea-University-10th-Anniversary-2004-2014
  • Swansea University Medical School has had spectacular success in the Research Excellence Framework (REF) 2014. Achievements include; joint 1st in the UK for research environment rated as 100% world-leading and 2nd in the UK for research quality in our unit of assessment, scored 100% world-leading in terms of impact and 95 % of the research submitted was assessed as world-leading (54%) or internationally excellent (41%). Find out more about the REF2014 results:  https://www.scribd.com/doc/250478133/College-of-Medicine-results-in-the-Research-Excellence-Framework-REF-2014
  • eHealth Digital Media Limited (EDHM) - a specialist health communications company - is working in close collaboration with expert patients, academics and NHS colleagues to produce the PocketMedic films. The aim is to roll-out the service, across the NHS, by 2020.  See: http://ehealthdigital.co.uk
  • PocketMedic films are produced by the award-winning documentary marker and filmmaker, Kimberley Littlemore, in partnership with expert patients and clinicians. The films are presented by Dr Jane Gilbert, a qualified doctor, health journalist and media medic. See: doctorjane.co.uk and PocketMedic 
  • The Welsh Government ‘Together for Health | Diabetes Annual Report 2015’, showed that, in Wales. only 0.9% of patients attends a structured educational course. This means that 99% of the 183,000 patients living with type 2 diabetes in Wales could benefit from watching one or more of the PocketMedic films.