A Florey allows you to send a questionnaire out to patients to gather data. The Diabetes Pre-Appointment Florey Questionnaire is used to help gather data that would be useful ahead of a diabetes review appointment. Using the information gathered, clinicians can determine the most helpful subsequent steps in the review e.g. video call.

Please note: This Florey is only available to users who are in an area that has purchased accuRx Plus.


Content

Enrolment SMS

Hi NAME,

We will be inviting you for a review of your diabetes soon. Please answer the questions in the link below to make sure the review is as useful as possible.

Thanks, SIGN-OFF



Please follow this link (link will autogenerate here).
You need internet on your phone (otherwise you can open the link on a computer or contact reception).
SENDER ID

First page of questionnaire

Hi NAME,

Your practice will be inviting you for a review of your diabetes soon.

To make this appointment as useful as possible, please answer the following questions.

This questionnaire will take about 5 minutes to complete.

Are you happy to proceed?

This survey is operated by accuRx.

Questions

What is your date of birth?
Example 8 12 1988

  • DD MM YYYY

Intro

The following questions will ask about certain lifestyle and health habits that may affect your diabetes.

1. Do you drink alcohol?

  • Yes
  • No

2. How often do you have a drink containing alcohol?

  • 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.

  • Less than monthly
  • Monthly
  • Weekly
  • Daily or almost daily

5. What is your smoking status?

  • Current smoker
  • Ex-smoker
  • Never smoked

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.

  • 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.

  • 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.

Picture of bp monitor with systolic reading highlighted.

  • Field for reading entry

13. Please enter your diastolic (DIA) blood pressure reading. This is the lower reading.

Note: This is NOT the pulse.

Picture of bp monitor with diastolic reading highlighted.

  • Field for reading entry

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 practice 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.

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

Response in accuRx Inbox

Patient NAME has responded:

Questionnaire : Diabetes Pre-Appointment Questionnaire

Drinks alcohol : Yes

Frequency of alcohol : Monthly or less

Typical units : 3 or 4 units

More than 6/8 (f/m) units in the past year : Monthly

Smoking status : Current smoker

Smoking quantity : 1-9 cigarettes or equivalent per day

Weight (kg) : 100

Height (m) : 1.9

BMI : 27.7

Systolic BP (mmHg) : 120

Diastolic BP (mmHg) : 90

Side effects from medication : Yes

Having yearly eye checks : Yes

Sexual function affected : Yes

Wants to discuss low mood/anxiety : Yes

Knows sick day rules : Yes

Anything else :

SNOMED codes saved to record

The codes added are in 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.

  • Systolic arterial pressure - 72313002
  • Diastolic arterial pressure - 1091811000000102
  • Weight - 162763007
  • Height - 162755006
  • BMI - 60621009
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