What is a Diabetes Pre-Appointment Questionnaire?
The Diabetes Pre-Appointment Questionnaire is used to help gather data that would be useful ahead of a diabetes review appointment. Using the patients’ responses, clinicians can determine the most helpful next-steps in the review.
🌟 Please note: This questionnaire is only available to users whose organisation has access to Accurx Plus 🌟
Enrolment SMS 💬
Once the patient has accessed the link, they will be prompted to enter their date of birth in order to access the questionnaire 📆
Questions
1. Do you drink alcohol?
Yes
Now
(💡 If answered ‘No ❌*’ it will take them straight to question 5*)
2. How often do you have a drink containing alcohol?
Never
Monthly or less
2-4 times per month
2-3 times per week
4 or more times per week
3. How many units of alcohol do you drink on a typical day when you are drinking?
(A pint of beer is around 2 units. A medium glass of wine (175ml) is around 2 units. A single measure of spirits is 1 unit)
1 or 2 units
3 or 4 units
5 or 6 units
7 to 9 units
10 or more units
4. How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?
(A pint of beer is around 2 units. A medium glass of wine (175ml) is around 2 units. A single measure of spirits is 1 unit)
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
5. What is your smoking status?
Current smoker
Ex-smoker
Never smoked
(💡 If answered ‘Ex-smoker’ or ‘Never smoked’, it will take them straight to the next information screen)
6. How much do you smoke?
<1 cigarette or equivalent per day
1-9 cigarettes or equivalent per day
10-19 cigarettes or equivalent per day
20-39 cigarettes or equivalent per day
40= cigarettes or equivalent per day
Information screen 📱💻
‘The following questions will ask you to submit some readings such as weight and blood pressure.
If you don't have the equipment to do this, you can skip the questions.’
7. Do you know your weight?
Yes
No
8. Please enter your weight in kilograms.
(If you only know your weight in stone and pounds, please use this converter here)
The field for weight entry
9. Do you know your height?
Yes
No
10. Please enter your height in metres.
If you only know your height in feet and inches, please use this converter here.
The field for weight entry
11. Do you have access to a blood pressure monitor so that you can submit a reading?
Yes
No
Information screen 📱💻
‘Before you take your blood pressure reading:
Sit down comfortably for 5 minutes.
Wear loose-fitting clothing.
Make sure your arm is around the same level as your heart.
Make sure your arm is relaxed.
When taking your blood pressure:
Put the cuff on following the instructions which came with your blood pressure monitor.
Keep still and silent.
Other tips:
Take at least three readings, each two minutes apart.
Your first reading may be much higher than the next readings. If this is the case, keep taking readings until they level out and stop falling. Use this as your reading.
Please seek urgent medical attention if you develop any of the following:
Blood pressure is 180/110 or above (despite repeating it at least 2 times)
Chest pain
Changes in vision
Confusion
Severe headache
Here is a video from the British Heart Foundation on how to take your reading.’
12. Please enter your systolic (SYS) blood pressure reading. This is the top reading.
13. Please enter your diastolic (DIA) blood pressure reading. This is the lower reading.
(Note: This is NOT the pulse.)
14. Are you having any side effects or problems from your medication that you would like to discuss with your GP/nurse?
Yes
No
15. Diabetes can sometimes affect your vision. Are you having yearly diabetes eye check-ups (known as retinopathy screening)?
Yes
No
16. Diabetes can sometimes affect sexual function such as difficulties with erections or vaginal dryness. Is this something you would like to discuss with your GP/nurse?
Yes
No
17. Diabetes can sometimes lead to low mood, worries or stress. Is this something you would like to discuss with your GP/nurse?
Yes
No
18. People with diabetes sometimes need to change the way they take their medication when they are unwell. Do you know your “sick day rules”?
Yes
No
19. Is there anything else regarding your diabetes that you would like us to know or discuss?
Free text field
After submitting ✅
‘Thank you for submitting information regarding your diabetes.
What next?
Your organisation will review this information in the next 28 days and be in touch if further action is required.
What to bring to your diabetes appointment?
Bring a urine sample to your appointment. You can pickup a urine pot at reception.
If you monitor your blood glucose at home, please fill a weekly diary and bring it to your appointment. A diary can be found on the Diabetes UK website here.
More information
The Diabetes UK website has more information on diabetes including information about treatments, diet, keeping active, regular check-ups and how to find further help and support. Click here to access this.’
💡 *If a patient has responded ‘Current Smoker’ to the question ‘What is your smoking status?’ they will also see...*👇
Smoking cessation advice
Smoking leads to health problems such as cancer, heart disease and strokes. The benefits of stopping smoking include: better health, more money and cleaner air for those around you!
Do you want to stop smoking? Here is some advice on ways to quit smoking, local services and general tips: nhs.uk/smokefree
Confirmation SMS:
Response in the Accurx Desktop toolbar: Diabetes Team 👇
Please then select the save to record button if you wish for these results to be saved to the patient's medical record 📚
SNOMED codes saved to record 💾
The codes added are in bold and italics
The following codes are also saved according to the patient's response:
"What is your smoking status?"
"Current smoker" - Current smoker
"Ex-smoker" - Ex-smoker
"Never smoked" - Never smoked
[if chose 'Current Smoker' above] 👇
Smoking: "How much do you smoke?"
"Trivial smoker (<1 cigarettes/day or equivalent)" - Trivial smoker (<1 cigarettes/day or equivalent)
"Light smoker (1-9 cigarettes/day or equivalent)" - Light smoker (1-9 cigarettes/day or equivalent)
"Moderate smoker (10-19 cigarettes/day or equivalent)" - Moderate smoker (10-19 cigarettes/day or equivalent)
"Heavy smoker (20-30 cigarettes/day or equivalent)" - Heavy smoker (20-30 cigarettes/day or equivalent)
"Very heavy smoker (40+ cigarettes/day or equivalent)" - Very heavy smoker (40+ cigarettes/day or equivalent)
Smoking cessation advice given - This code is added for anyone who says they are a current smoker.
We display a standard short bit of smoking cessation advice with link to nhs.uk/smokefree.
Blood pressure readings:
Self reported systolic blood pressure (Concept ID: 1162737008 / CTV3 2469)
Self reported diastolic blood pressure (Concept ID: 1162735000 / CTV3 246A)
Weight - 162763007
Height - 162755006
BMI - 60621009
If you still have any questions or concerns, feel free to chat with us using the green message bubble in the bottom right-hand corner of this page. 👉