Transcript Enhancing Communication Through Technology

Enhancing Communication Through Technology
Presented by: Debbie Hollahan, RN, BHScN, CDE
Coordinator, Diabetes Care Centre
The Credit Valley Hospital
Objectives
• To discuss challenges/barriers present
• To share experience with the wireless
program in our Diabetes Care Centre
• To share challenges/successes
• To discuss potential
What we know:
• Diabetes is a life-long disease
• Many of the complications from diabetes
can be prevented
• Diabetes costs are escalating
• We have effective pharmaceutical
therapies available
• Diabetes can be self-managed given the
proper education, support and tools
• Science says we should
• Economics says we should
yet….
• 49% of individuals with diabetes in Canada are
not at target
Diabetes in Canada Evaluation (D.I.C.E.) Executive Summary, CDA.
AADE Nationwide Survey, May 2006
• Survey conducted in April 2006
• Patient survey: 784 adults with Type 2 diabetes
• Primary care physicians: 406 physicians who
see at least 3 Type 2 diabetes patients/month
AADE, May 2006. http://www.diabetesteamsite.com
AADE Nationwide Survey, May 2006—patient
response
• 69% of patients feel very knowledgeable or
knowledgeable about managing their condition
• 83% of patients think they are self-managing their
disease well
• 76% reported experiencing symptoms
• 55% don’t know their A1C
AADE, May 2006. http://www.diabetesteamsite.com
AADE Nationwide Survey, May 2006—
physician response
• 29% believe their patients are self-managing
their diabetes well (compared to 83% of
patients belief)
• 18% of physicians believe their patients
comply well with their physical activity
(compared to 77% of patients belief)
• A disconnect!!
AADE, May 2006. http://www.diabetesteamsite.com
Why the disconnect?
• People do not always know what they need to know
• Patient’s recall and comprehend as little as 50% of
what their providers tell them*
• Very busy lifestyle
• Access to internet
• “feel fine”
• Many don’t take it seriously
• Attend Diabetes Education because their doctor told
them to
*Rotter, Geriatric Medicine, 2003
Challenges with reaching people
• 27% to 35% of people with diabetes ever receive
diabetes education*
• 66% have visited a Diabetes Educator**
• 10-15% of diabetes population we serve
• 10% of diabetes related admissions and emergency
services were referred to DEC***
• <30% of people return for follow-up****
*Group Practice Journal 1996, pg. 11, DMTC, 2001.
**Diabetes in Canada Evaluation (D.I.C.E.) Executive Summary, CDA.
*** 2002 Self-Assessment and National Recognition Program
**** Data collected from CVH Diabetes Care Centre, CVH, 2004
?Expectations
• A life-time of decision-making and self-care
cannot be obtained from one visit to a Diabetes
Centre
• Ongoing follow-up and support is essential for
good adherence to care
• Support is required from multi-disciplinary team
Diabetes Care Reality Check
• The patient delivers
ninety percent of the
care
• Even the best regimen is
doomed to failure without
the patient’s skillful
implementation
Learning to make a difference: DMTC 2001
How do we reach the patient?
• We must market ourselves better
• We must be available and accessible
• People with diabetes must understand why it is
important to them
• Must value the outcome
• Need to understand why?
– Testing times
– Why strive for target?
– What to do with results
• People must feel supported and encouraged
Evolution of Diabetes Education
• Diabetes educators have
evolved over time
• Recognize the stages of
change
• Empowerment
• Health beliefs
• Adult learning principles
• Focus is on delivery of
education
Delivery of Care
• Recognize the limited resources available to
manage the diabetes population
• Must look at efficient tools for delivery of care
• Maintain the quality
• Build and sustain relationships
• Encourage self-management
• Provide “user-friendly” tools for the person with
diabetes
Wireless Diabetes Program Experience
Current process of communication
1. Phone:
•
•
•
Voice mail back and forth
Pt reads off blood sugars
Review blood sugars, make recommendation
2. Fax:
•
•
Receive faxed version (illegible, forget to put name on
fax, or address it to appropriate nurse)
Reply with phone..voice mail…
3. E-mail:
•
•
•
Good method
Patients use variety of forms (spreadsheets, type out
results)
Privacy issues
4. Visit:
•
•
Often forget log-book or meter
Rely on memory/recall
Notes from phone conversation
Faxed copy
Objectives of wireless study
• To determine if the wireless program would:
– provide an efficient method of communication
for Centre
– enhance communication
– enhance support thereby improving adherence
Study
•
•
•
•
Received ethics approval
Enroll 25 patients
A1C at start and at 3 months
Satisfaction questionnaire at end of 3 months
Challenges with start-up—Staff
• Slow to recruit patients
– Initially targeting insulin dependent pts.
– Too much information at first visit
• Staff were slow to “buy-in”
– Overwhelmed with technology/volume
– Resistant to change
– Concern that it would develop dependency vs self
management
– Not able to assess other factors, ie. diet, exercise
Overcoming challenges with staff
• Allow time
• Recognize it is a complimentary tool to communication
• Share experience
– Review and reply to 7 patients in several minutes
• Include other types of patients, ex. Type 2
– Helps them to stay on track
– Support
– Reminder to test after meals
• “Stepping stone” to self-management
Challenges with start-up--patients
• Patients were hesitant
due to
– Cost
– Already had ability to
communicate ie.
Phone, fax, e-mail
Overcoming challenges with patients
• Cost issue —purchase plan with cellular companies;
minimal time
• Easy and timely to submit
• Support and encouragement
• Type 2:
– traditionally, pt’s don’t want to bother us
– Provides additional support
Steps to successful implementation
• Allow sufficient time for “buy in” from staff
• Support from Info systems
• Right “sell”: more than a communication tool—
added support
• Pt. must have web access on phone
Next steps
• Continue to recruit
patients
• Collect outcome data
• Continue to build on
system
• Include physicians on
system to enhance
communication
Summary
• We must develop efficient tools to manage the volume
of diabetes
• The wireless diabetes program provides a
complimentary tool to communication
• For educators, it offers an efficient way to observe and
respond to patients
• For patients, it offers additional support and
encouragement
• It provides a stepping stone for self-management
“The great aim of education is not knowledge but action”
(Herbert Spencer)
Thank you!!