DAWN is an innovative project funded by the Health Foundation’s Shine 2011 programme. It aims to transform diabetes care, replacing routine outpatient appointments where no physical examination is required, with web-based consultations.
Shanti Vijayaraghavan, DAWN’s clinical lead, talks about how the project is developing.
Where did the idea for the DAWN project come from?
In February 2010, I was asked to do a small project for NHS Choices, looking at webcam consultations. My specialist nurse and I recruited 15 patients from my young adults diabetes clinic in Newham, and used video-conferencing software to conduct two routine appointments, followed by an online questionnaire.
Newham has a high prevalence of diabetes, and the clinic struggles with low attendance of outpatient appointments, which contributes to poor health outcomes. Using the new webcam system, nobody missed an appointment – they loved this new way of interacting.
How did you develop the idea?
We did a three-month scoping exercise to look at expanding web consultations to other age groups. We were surprised that about 80% of patients agreed to a web consultation, and at least 70% had internet access, regardless of age or ethnicity.
We applied for the Shine 2011 award to continue exploring how the online system could improve efficiency. Everyone with an appointment at the general diabetes clinic or young adults clinic was offered a web consultation if clinically appropriate, and we measured how many accepted from each age group. We created an easy step-by-step guide to the system, giving extra support where necessary.
We have continued to capture information about the effectiveness of consultations, patients’ blood tests, blood pressure, weight and other clinical parameters, and we work with an academic who interviews patients about their experience of web consultations.
What do you hope the project will achieve?
We believe that a system of web consultations could better fit people’s lifestyles, proving more convenient and improving their self-care as a result. Not only does it give patients more choice, it’s also more efficient for clinics, saving time and costs.
What's most exciting about this project?
Web consultations bring a lot of flexibility. We discovered that a lot of our patients already use Skype to contact friends and family, so we’ve started holding Skype consultations too.
Thanks to web consultations, some people now attend appointments from their mobile phone at work or college. They find it causes less interruption in their day and takes less time. In future, we hope to call patients with an appointment reminder.
Have you come up against any barriers?
Patients sometimes forget online appointments, hence the need for a reminder system. Not everyone has broadband, or is comfortable using technology. Where people would like online consultations but can’t access the internet, we’re looking into online appointments from local GP surgeries.
What results have you seen so far?
Feedback shows that web consultations enable patients to feel more in control of the care process, giving them a sense of ownership and helping self-management:
'It’s brilliant. It was a ten-minute appointment. Getting to the clinic takes longer. It saved so much time. It’s for busy people with busy lives.'
'Sometimes in hospital I’ve felt the doctor was in control and you don’t want to waste their time but I want to get back to work… you feel liberated in your own home, it’s on your terms.'
We’ve recorded some cost savings so far, and we’re able to predict future savings. The biggest saving relies on reorganising the outpatient care path, establishing different clinics for web versus face-to-face appointments. If we could do that, we should see significant results.
Have you got plans to extend the project?
We would like to work with the hospital’s IT, estates and finance partners, to look at embedding web consultations in routine clinical care. We would also like to roll this out to people in the maternity clinic, people with multiple demands on their time, those who are home-bound or have limited mobility.