Enhancing Communication Through Technology

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Enhancing Communication Through Technology

• Presented by Debbie Hollahan, RN, BHScN, CDE
• Coordinator, Diabetes Care Centre
• The Credit Valley Hospital

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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

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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

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• 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.
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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
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AADE Nationwide Survey, May 2006patient 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 dont know their A1C

AADE, May 2006. http//www.diabetesteamsite.com
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AADE Nationwide Survey, May 2006physician
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
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Why the disconnect?

• People do not always know what they need to know
• Patients recall and comprehend as little as 50
  of what their providers tell them
• Very busy lifestyle
• Access to internet
• feel fine
• Many dont take it seriously
• Attend Diabetes Education because their doctor
  told them to

Rotter, Geriatric Medicine, 2003
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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
• lt30 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

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?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

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Diabetes Care Reality Check

• The patient delivers ninety percent of the care
• Even the best regimen is doomed to failure
  without the patients skillful implementation
• Learning to make a difference DMTC 2001

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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

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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

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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

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Wireless Diabetes Program Experience
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Current process of communication

• Phone
• Voice mail back and forth
• Pt reads off blood sugars
• Review blood sugars, make recommendation
• Fax
• Receive faxed version (illegible, forget to put
  name on fax, or address it to appropriate nurse)
• Reply with phone..voice mail
• E-mail
• Good method
• Patients use variety of forms (spreadsheets, type
  out results)
• Privacy issues
• Visit
• Often forget log-book or meter
• Rely on memory/recall

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Notes from phone conversation
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Faxed copy
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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

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Study

• Received ethics approval
• Enroll 25 patients
• A1C at start and at 3 months
• Satisfaction questionnaire at end of 3 months

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Challenges with start-upStaff

• 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

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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

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Challenges with start-up--patients

• Patients were hesitant due to
• Cost
• Already had ability to communicate ie. Phone,
  fax, e-mail

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Overcoming challenges with patients

• Cost issue purchase plan with cellular
  companies minimal time
• Easy and timely to submit
• Support and encouragement
• Type 2
• traditionally, pts dont want to bother us
• Provides additional support

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Steps to successful implementation

• Allow sufficient time for buy in from staff
• Support from Info systems
• Right sell more than a communication
  tooladded support
• Pt. must have web access on phone

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Next steps

• Continue to recruit patients
• Collect outcome data
• Continue to build on system
• Include physicians on system to enhance
  communication

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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

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The great aim of education is not knowledge but
action (Herbert Spencer)
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Thank you!!