The 3 pillars
GUARDIANS FOR HEALTH
[The GUARDIANS FOR HEALTH approach: The 3 Pillars][Professor Javed ButlerUniversity of Mississippi Medical Center, USA][SC-CRP-08003]
[Prof Javed] GUARDIANS FOR HEALTH, a bold initiative to improve the care and outcomes of patients living with diabetes.[Affiliation appears on screen: Professor Javed ButlerUniversity of Mississippi Medical Center, USA][Footnotes added to screen:*SGLT2 inhibitors or GLP-1 RA/ACE inhibitors or ARBs/high-intensity statins.ACE: angiotensin-converting enzyme; ARB: angiotensin receptor blocker; GLP-1 RA: glucagon-like peptide-1 receptor agonist; SGLT2: sodium-glucose co-transporter-21. Nelson AJ et al. J Am Heart Assoc. 2021;10:e016835; 2. Arnold SV et al. Circulation. 2019;140:618–620.]
[Text on screen: GUARDIANS FOR HEALTH – why, what, and how?] [Footnotes on screen: *SGLT2 inhibitors or GLP-1 RA/ACE inhibitors or ARBs/high-intensity statins.ACE: angiotensin-converting enzyme; ARB: angiotensin receptor blocker; GLP-1 RA: glucagon-like peptide-1 receptor agonist; SGLT2: sodium-glucose co-transporter-21. Nelson AJ et al. J Am Heart Assoc. 2021;10:e016835; 2. Arnold SV et al. Circulation. 2019;140:618–620.] [Prof Javed] You might wonder, what is the need for this program? What is it trying to achieve? How will we achieve it?
Less than 10% of patients with type 2 diabetes and cardiovascular disease receive all treatments that are known to improve outcomes, and are recommended by the guidelines. This is one of the major reasons that these patients continue to suffer from high rates of morbidity and mortality.
The vision of Guardians for Health is to stop early mortality by reducing cardiovascular and kidney complications in people with type 2 diabetes.
And the programme aims to achieve this by driving the use of guideline-recommended therapies for cardio-renal protection in these patients.
[Text on screen: GUARDIANS FOR HEALTH aims to drive better implementation of guidelines and evidence-based therapies through 3 pillars] This approach is made up of 3 key pillars. None of this can achieve success on their own, but together they have the ability to make a true impact on everyday clinical practice, and ultimately on patient outcomes.
First, assemble a community of implementers. Guardians for Health is a movement of like-minded healthcare providers and organisations who want to make a difference in type 2 diabetes care, and are committed to bringing the Guardians for Health ambition to life.
Individuals who commit to the vision and mission, as well as organisations, are very welcome to join the community. Let's work together towards our ambition.
Second, create tools that can help achieve our goals. Practical tools that support implementation of guidelines and shared decision-making will be made available and shared.
These tools may range from a simple checklist to more complex digital solutions, and are provided to support clinicians in making evidence-based and individualised decisions and recommendations.
In addition, people living with type 2 diabetes will receive support to take responsibility for their own care and be a partner in shared decision-making with their clinicians.
And third, quality assurance. With medical education and performance tracking measures, we will ensure quality improvements are made along the way.
Together, through these three pillars we strive to achieve our vision. Now let us take a look at each pillar in turn.
First, let's now have a closer look at the community of implementers.[Text on screen:GUARDIANS FOR HEALTH aims to drive better implementation of guidelines and evidence-based therapies through 3 pillars]
The people and the organisations who will drive guideline implementation and bring our vision to life. So as a clinician, you're enthused by the vision and mission of the Guardians for Health. But how can you make an impact?
[Text on screen: The global GUARDIANS FOR HEALTH community unites like-minded HCPs on multiple levels][Footnotes on screen: HCP, healthcare professional]As with all powerful movements we need to act locally but think globally and build a powerful community.
It all starts with the individual who wants to make a difference in type 2 diabetes care.
You will certainly have colleagues and a network on a local level you rely on, and maybe you can immediately think of specific people who would be committed to joining this community.
Together we can already start to make an impact on everyday management of type 2 diabetes in our daily workplace.
Your national steering committee helps to connect the dots and be vocal about the vision, mission and approaches across the regions.
Wouldn't it be great to know who else in your country is following the same ambitions and exchange and learn from them, and share your ideas? Guardians for Health will facilitate this type of exchange and make visible who is involved.
However, we will not stop here. Type 2 diabetes is something that affects people around the world. Starting with a few specific countries we will work together to expand over time. The global steering committee ensures that we join our forces on an international level and make the movement even stronger.
Importantly, all that we need to start is a strong motivation to apply evidence-based approaches in type 2 diabetes and guideline implementation.
[Text appears on screen:GUARDIANS FOR HEALTH aims to be a multi-partnership initiative] As an active and enthusiastic community, together we will inspire people to help us strive towards achieving our vision.
With your help we aim to grow and build the community further by partnering with clinicians, medical societies, patient organizations, industry partners and academia, at a local and national level.
[Text appears on screen: A like-minded and multi-disciplinary community committed to help bring the GUARDIANS FOR HEALTH ambitions to life] These partnerships will, among other things, bring ideas, experiences and learnings to the initiative.
If you agree with the Guardians for Health vision, why not commit to making a difference in type 2 diabetes and declaring yourself a member of our community.
[Text on screen:Do you say YES to the vision, and to joining our community? GUARDIANS FOR HEALTH membershipAre you ready to commit to:•The vision?•Providing guideline-based care as appropriate?•The concept of driving guideline implementation and application of evidence-based management to type 2 diabetes care]
By becoming a member you commit to the vision that premature mortality in patients with type 2 diabetes should be stopped by reducing cardiovascular and kidney complications.
Providing guideline-based care as appropriate and thereby offering the best opportunity to reduce cardio-renal complications and reducing premature mortality in patients with type 2 diabetes, the concept of driving guideline implementation, and application of evidence-based management to type 2 diabetes care to reach these goals.
[Text appears on screen: Visit guardiansforhealth.com and sign-up for free membership today Download your certificate Inspire others to join the mission]As a member, you will be connected with the global Guardians for Health community.
Moving on now to tools, our second pillar.[Text on screen: GUARDIANS FOR HEALTH aims to drive better implementation of guidelines and evidence-based therapies through 3 pillars][Footnotes on screen:HCP, healthcare professional]
Tools are a means to achieve our mission by driving broad and routine implementation of guidelines for cardiorenal protection, as well as shared decision-making between healthcare professionals and their patients with type 2 diabetes.[Text appears on screen: Tools to support evidence-based decision-making during routine diabetes care appointments]
These tools available for Guardians for Health will support healthcare professionals in primary care with the multiple assessments and decisions that typically need to be made during a routine diabetes appointment.
The objectives for the tools are to provide support for identification of areas where treatment adjustment is needed, easy access to guideline recommendations for cardio-renal protection, making treatment
decisions and receiving decision support, improving the value of clinician-patient interaction and shared decision-making, helping people with type 2 diabetes to better understand their disease and thereby empowering them to take ownership of their health plan.
There are a number of Guardians for Health tools currently in development, and you may be invited to contribute to their testing and development.
[Footnotes appear on screen: HCP: healthcare professionalTools are being developed and tested in selected countries; adaptation for use in other countries may be subject to legal and technical restrictions]Please contribute to making them as useful as possible for diabetes care appointments in your country or region.
These include patient booklets. This provides the patient with information and an overview of their risk factors and management plan. Digital decision support tool. Its purpose is to assist clinicians in individualising guideline-based treatment recommendations.
Dashboard trackers to provide an overview of patients’ cardiovascular and renal risk for clinicians and to support dialogue about the risk management for patients. Specialist consult email template.
An automatic email generated from the dashboard to obtain virtual advice from a specialist. Guideline synopsis and comparator tool. An overview of recommendations related to cardio renal protection from the relevant guidelines.
[Text on screen:Tools to support evidence-based decision-making during routine diabetes care appointments][Footnotes on screen: HCP: healthcare professional] Besides the tools supplied by Guardians for Health, we welcome recommendations for other pre-existing tools
that you or your colleagues may have used in your own practice that complement and align to our mission and vision. Sharing best practice is valuable, and any relevant recommended tool can be tailored and made available widely within our Guardians for Health community when appropriate.
[Text on screen: GUARDIANS FOR HEALTH aims to drive better implementation of guidelines and evidence-based therapies through 3 pillars] The third pillar of Guardians for Health, quality assurance, is vital to measuring our impact and whether we are improving outcomes in type 2 diabetes.
[Text on screen: GUARDIANS FOR HEALTH aims to ensure quality improvements through performance tracking and feedback] Medical education tailored to the mission of Guardians for Health aims to contribute to quality improvement through a continual cyclical five-step process.
By asking ourselves key questions and capturing outcomes, identifying improvements and implementing changes, we have the potential to achieve tangible reductions in cardiovascular and kidney complications by increasing the use of guideline-recommended therapies.
In order to measure changes in adherence to guideline-recommended therapies, it is important that we continually ask questions in our everyday clinical practice. In this way we are able to establish the existing status and identify gaps for improvement.
[Text appears on screen:What percentage of my patients with type 2 diabetes are currently on guideline-recommended treatments?] For example, what percentage of my patients with type 2 diabetes are currently on guideline-recommended treatments?
[Text appears on screen:Which of my patients with type 2 diabetes are not treated in line with guidelines? Why?] By analysing your current status, you may identify some gaps by asking questions such as, which of my patients with type 2 diabetes are not treated in line with the guidelines? And why is this?
The next step in quality improvement requires some thought and discussion within your own multidisciplinary team. Which changes do we need to make?
Other questions you may ask include: What are the priorities? What are the easy to implement changes and quick wins to ensure best management? In other words, what are the critical moves?
[Text appears on screen: How?] But also, importantly, how exactly do we want to execute these? To give you an example, you may want to go through the records of each person with type 2 diabetes and cardiovascular disease to check what medications they are on,
whether they are taking an ACE inhibitor or an angiotensin receptor blocker, an SGLT2 inhibitor or GLP-1 receptor agonist, statin and aspirin, and ensure they are indicated accordingly.
You could adapt an approach whereby you screen upcoming appointments for patients at the beginning of the week to identify opportunities to improve and design a system to remind yourself to discuss it with the patient.
Approaches in decisions in clinical practice can then be optimised by implementing available tools and adopting new behaviours. Questions here include, which tools and behaviours do I want to implement?
For example, am I using the most appropriate medications for risk reduction? Am I individualising and achieving targets? What does the new standard look like?
[Text appears on screen:Training, adapt, make use of tools, and make new behaviours a habit] And then of course we execute these changes through training, routinely using these tools, and ensuring that the new behaviours we have adopted become habitual.
[Text appears on screen:•Are comorbidities being assessed regularly?•Is medication for risk reduction being used?•Are targets individualized and are they being achieved?] The final step in the process is to track the changes that have been made to assess their impact.
For example, by assessing the performance of your type 2 diabetes patient caseload. How can you quantify progress in your daily practice? For example, you may have a functionality in your electronic health record system that would be helpful.
Some key questions to ask here are, are comorbidities being assessed regularly? Is medication for risk reduction being used? Are targets individualized and are they being achieved? Through this process, you as healthcare professionals really have the potential to induce change in type 2 diabetes.
[Text on screen: GUARDIANS FOR HEALTH aims to provide medical education as guidance for implementing evidence-based decisions] As well as performance tracking, Guardians for Health will provide medical education to help ensure quality improvement.
Some of the content available includes short educational videos with downloadable slides. For example, 24-hour blood pressure measurement, dosage, and up-titration of metformin. What do I need to consider?
Screening for comorbidities is screening for risk factors, an animation with accompanying slides to highlight the essential messages of Guardians for Health, a guideline synopsis resource to provide an
overview of key recommendations related to cardio-renal protection from relevant guidelines, direct links to pre-existing external resources and websites. Please visit the Guardians for Health website to access all of this content.
[Text on screen:GUARDIANS FOR HEALTH aims to drive better implementation of guidelines and evidence-based therapies through 3 pillars] Through these three underpinning pillars of Guardians for Health, and your commitment, I am confident that we can achieve our vision to stop early mortality in people with type 2 diabetes.
[GUARDIANS FOR HEALTH] [guardiansforhealth.ca]