Ann O'Hanlon


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Ann O'Hanlon

  1. 1. Telehealth Trial in Ireland Netwell Centre and CASALA
  2. 2. Need for Research  People are living longer than ever before given achievements in medicine, health and social care. how do professionals bring quality of life and health to increased longevity?  Telehealth is the delivery of health-related services and information via telecommunications solutions. Has many advantages: increased knowledge re illness (Wakefield et al, 2009) delayed readmission relative to control group (Wakefield et al, 2009) fewer emergency department visits (Barnason et al, 2005) improved psychological functioning: reduced anxiety and depression, greater empowerment and confidence
  3. 3. Telehealth Health Buddy © - Small communications device (6X9 inches approx) - Illuminated screen and four large buttons - Attaches to phone but does not interfere
  4. 4. Research Questions • Attitudes of older people and associated health professionals towards telehealth? • Efficacy of telehealth for improving outcomes with patients who have CHF and / or diabetes?  Associations with physical, social and psychological well-being?  Changes in knowledge, behaviour (diet, weight, medication compliance), and / or medical outcomes?  Cost – benefits?
  5. 5. Trial: Method • A repeated measures design – Patients enrolled and then randomised to intervention (n=30) or routine care (control) groups (n=10) – Baseline assessments; follow-up at 6 weeks and 3 months. • Measures: Baseline + 3 months – Baseline: Interview • Health history • Attitudes and experiences to technology – Baseline: General survey • Physical health • Relationships • Psychological functioning • Use of services Measures & indicators ...
  6. 6. Technology users % (n=30) Control group % (n=10) sig. Age - ≤74 years - 75+ years 47% 53% 40% 60% ns Sex - Male - Female 57% 43% 20% 80% .05 Chronic Illness - CHF - Diabetes 50% 50% 50% 50% ns Use computers? - Yes - No 29% 71% - 100% ns Digital TV? - Yes - No 32% 68% 50% 50% ns Use mobile phone? - Yes - No 79% 21% 83% 17% ns Sample
  7. 7. And did you find the Health Buddy hard to use? - “Not at all. A child could use it” (F82) - “I didn't have any bother at all” (F89) - “Not at all. There was a couple of times I pressed the wrong button but you got used to it then” (M78) - “There are only four buttons on it …. It’s very easy to use”. (M85) - “Initially for couple of days to get used to it there was a couple of wee things. I didn't do much wrong, I forget what it was (what I did wrong), but Sharon sorted it out anyway (F74) - No, no I think most people can use it. … No you didn’t have to give it much thought it was straight forward (F74) Ease of Use: Older people
  8. 8. • Yeah, I think they find it easy. And even one or two at the beginning that we thought ‘oh I wonder will they manage it’ actually have managed it quite well. Nobody has come back and said there's any big problem with working it or anything. Clinical Nurse Specialist Ease of Use: Professionals
  9. 9. How have you been getting on with the Health Buddy? “It’s a great thing, there's no doubt about it. It is very handy. It leaves you with a bit of confidence that there's someone there to talk to. You know what I mean? You can correspond with it or get in touch with them (nurses), and there's someone monitoring the results” (F82) “It is great to think that there’s somebody else at the other end of the phone if there was an emergency because you know what it’s like with doctors and hospitals, you have to wait your turn. In that respect, I think it’s marvellous.” (F78) “I was always taking my sugar levels anyway three and four times a day sometimes but it will tell me you’re a bit high or a bit low and even though I know that myself, it’s reassuring to see it on the Buddy (M74) Reassurance and confidence
  10. 10. Improved self-care Now before I got that little thing there (points to the Health Buddy), I‘d get up in the mornings and I’d take me weetabix, but I’d never take me blood sugar beforehand. From I got that, that’s the first thing I do, first thing in the morning and last thing at night I take that. You look after yourself more, do you know what I mean? It makes you more conscious (F82)
  11. 11. I had a few drinks and I come home late and took my blood pressure (on the Helath Buddy) and .. it was 182 over 70. … My father went to a wedding years ago and … he had a stroke do ya see. … But then I said to myself that’s what happened to my father do ya see. I would never have known, well no one ever told me with this diabetes that … the drink would drive the blood pressure up mad. I couldn’t believe what I seeing coming up on the screen. Well if you’re going to get your blood pressure taken .. you wouldn’t go down to the doctor with your heart full of drink like, ya know what I mean. I would never have known other than the fact that the Buddy was there. It would never have dawned on me that the blood pressure would go up like that with the drink. I wouldn’t have that many drinks now. (M66) Patient learning: Improved health
  12. 12. Sandra’s Story • 86 year old female, widowed, three children who live nearby (excellent relationships with each); lives alone but someone stays with her at night. • Diagnosed with heart problems for 7 years; diabetes for one year; • Believes she is “quite knowledgeable” about her heart problems, but she also gets frustrated by them. • Summarises her attitudes towards the technology as ‘neutral’. • Alarm triggered for high BP reading (145/118) • Clinical triage assessement and asked Sheila to recheck and re-do her BP – Health Buddy data showed she had taken her medication – Her CNS was called, who contacted Sheila again for another reading. BP still high – CNS contacted consultant, said BP dangerously high, and increased her anti-hypertensive medication. • She was then recommended further tests, incl 24-Hour BP monitoring.
  13. 13. More widespread use So you reckon that more people should have these devices in their homes? • Yes, there's no doubt about it. What roughly would they cost? (M74) • Yes, its definitely great that you have someone there all the time and you can ring them up or ring the nurse. It’s definitely a great thing to have (F74) • It is my buddy (laughing). It’ll be hard to give it up (F82).
  14. 14. Professionals views: Positive I think it’s great and the feedback that we’re getting from those that are on it, they think it’s great. … I can see where they’re benefiting, not just from their diabetes management because again, they’re getting all the extra wee bits of information that maybe we would have told them at some stage but maybe they’d have forgotten, which is understandable. No matter what age you are you need to be reminded of things. Clinical nurse specialist
  15. 15. Other colleagues views I've spoken to some of the other girls, because I would be involved with the Irish Diabetes Nurse Specialist Association so I’d be meeting the others from all around the country. I've been telling them about it and they’re very interested. I suppose the worry, like with any technology, is you’re worried that it’s going to take the place of the people that are doing it. But I can’t see in diabetes things like that are going to take the place because we’re all going to have clients. There’s never going to be a shortage of patients as such. Clinical nurse specialist
  16. 16. Professionals: Triage and filtering At the minute I have to say I like the idea of the call centre because, to be honest, there's days we wouldn’t even get to turn on that computer. … I suppose the fact that you have the call centre and you have somebody there who is assessing it and working within the parameters that we’ve established for each person, that's good. And then the likes of Sharon or whoever would be there. I there was something urgent that she would ring us and say ‘look, I’m concerned about this person.’ So that's good that it’s being sort of filtered for us. Clinical Nurse Specialist
  17. 17. Discussion • Attitudes of older people to the Health Buddy – Psychological: More reassurance and confidence; patient learning and empowerment – Physical: Improved health status (e.g. blood pressure); greater self-care – Cost-benefits: Prevention; fewer GP or hospital visits • Findings for professionals – Encouraging feedback from patients – Helpful in workload • Further information – Full research paper available later this year.
  18. 18. Thank You For more information: