Telehealth Trial in Ireland
Netwell Centre and CASALA
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
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
• 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?
• 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
• Measures: Baseline + 3 months
– Baseline: Interview
• Health history
• Attitudes and experiences to technology
– Baseline: General survey
• Physical health
• Psychological functioning
• Use of services
Measures & indicators ...
- ≤74 years
- 75+ years
Use mobile phone?
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
- “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
Ease of Use: Older people
• 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
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.”
“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
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
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
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
• 86 year old female, widowed, three children who live nearby (excellent
relationships with each); lives alone but someone stays with her at
• 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
– 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
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
• 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).
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
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
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
• 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
• Findings for professionals
– Encouraging feedback from patients
– Helpful in workload
• Further information
– Full research paper available later this year.
For more information: