Evaluations of DESMOND continue to show effectiveness
The DESMOND program is regularly evaluated and reviewed to ensure that it is helping people to manage their diabetes. There are a number of ways to measure effectiveness and Diabetes WA currently uses a range of internationally validated scales to examine the impact of DESMOND on self-management behaviours, including the Diabetes Empowerment Scale (DES-SF), Problem Areas in Diabetes Scale (PAID) and the Patient Activation Measure (PAM). PAM is receiving growing international attention as a way to tailor care for patients to provide the right level of support appropriate to their needs and readiness, and also as a measure of intervention effectiveness due to its unique measure of engagement and empowerment.
Patient activation is a behavioural concept that describes the knowledge, skills and confidence a person has in managing their own health care. More activated patients have fewer hospital admissions, make more effective use of health care resources and are more likely to adopt healthy behaviours, compared to less activated patients.
In 2018 Diabetes WA’s evaluation team measured the activation of 510 people with type 2 diabetes using the PAM before and immediately after attending DESMOND. In March 2019 they presented their findings at the Diabetes UK conference in Liverpool.
Overall median PAM scores increased by 9.7 points post-DESMOND. Furthermore, a significant increase in the proportion of people scoring in the highest
level of activation was observed. Higher patient activation scores have been linked to improved self-management behaviours, better clinical outcomes and reduced cost of delivering care. International evidence suggests that for every one-point increase in PAM score, the likelihood of hospitalisation for a chronic condition decreases by 1.7%. Thus a 9.7-point increase in PAM score could decrease the likelihood of hospitalisations due to diabetes and its complications by up to 16%.
Work is ongoing at Diabetes WA to establish whether increases in patient activation achieved in the DESMOND program are maintained over time.
Several previous international independent studies have shown the positive impacts of the DESMOND program, including HbA1c, weight loss, smoking cessation and cost effectiveness. Links to some of them are below.
“Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial” - 2007; publication: BMJ
“Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis” - 2010; publication: BMJ
“Real-world evaluation of the DESMOND type 2 diabetes education and self-management programme” - 2018; publication: Practical Diabetes