A comprehensive approach
to diabetes selfmanagement support
R Whittaker, D Bramley*, K Carter, R Cutfield*, R
Dobson, E Do...
NIHI mHealth research

• Using expertise & evidence in
behaviour change techniques
• Applying to unique benefits of
the te...
Why mobile technology?
•
•
•
•
•
•
•

Increasingly omnipresent (mobile phones, tablets)
Removes tyranny of time and distan...
mHealth:
transforming healthcare delivery
From provider & location-centric care to:
• anywhere, anytime care

• community ...
Educating

Empowering

Patients/
Popn

helping people to live healthier lives, reducing
demand for expensive resources

Pr...
mHealth Interventions
• Text messaging smoking cessation
• Video messaging smoking cessation
• Multimedia messaging depres...
Conceptualisation
- Evidence
- Experts
- Population

Whittaker R, Merry S, Dorey E & Maddison R (2012): A Development and ...
What is the issue?
• Rising prevalence of diabetes
15.8%

24,000 Waitemata
residents
System-wide process
•
•
•
•
•
•
•
•

Involve stakeholders
Establish Maori Advisory Group
Identify their issues and gaps
Id...
What is the problem we are trying
to address?
• How to support & enhance self-management of
diabetes to prevent/slow progr...
Self-management support landscape

Whanau
Community

Population
health
National
Regional
District
Locality
PHO

Pharmacy

...
Potential tools
Telemonitoring
Text messaging

Education programmes

Smartphone apps
eTherapy

Video conferencing

Populat...
How do they address the gaps?

Educating

Patients

Empowering

Smartphone apps, smart glucometers, SMS,
websites, telemon...
Tools
1.
2.
3.
4.
5.
6.
7.

Virtual Diabetes Register
Shared Care Plan
Primary care collaboratives
Specialist team support...
Population data for
high level planning
and targeting
services
• Virtual Diabetes
Register
Sharing health information & care plan
Motivation & support for self-management
• People with poor control who want extra
(automated) support between visits / at...
SMS4BG
• Maori/non-Maori versions
• Options
– Reminders for glucose monitoring
• Graphed on patient portal

–
–
–
–

Insul...
SMS4BG Pilot study
42 people (with mean HbA1c=85) received
programme for 3 months
“loved it”

“halved my HbA1c”

“lost 7 k...
Intensive home monitoring support
Need for a short-term structured programme for
starting on insulin
– Motivation & suppor...
Point of purchase dietary advice
FoodSwitch
smartphone app
& nutrient
database
- do we need a
specific version
for people ...
Specialist support in the community
Video conferencing
– Paper rounds and advice by specialists with primary
care teams
– ...
Educating

Empowering

Patients

SMS4BG
FoodSwitch

SMS4BG
Home monitoring
SCP
Virtual clinics

Providers

Up-skilling pri...
Where to?
An integrated comprehensive IT-enabled system
to support self-management & better control of
diabetes
Population...
Acknowledgements

Thank you
r.whittaker@nihi.auckland.ac.nz
@rawegd
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A Comprehensive Approach to Diabetes Self-management Support

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Presented by Robyn Whittaker
National Institute for Health Innovation, University of Auckland

Published in: Health & Medicine, Technology
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A Comprehensive Approach to Diabetes Self-management Support

  1. 1. A comprehensive approach to diabetes selfmanagement support R Whittaker, D Bramley*, K Carter, R Cutfield*, R Dobson, E Dorey, H Eyles, C McNamara*, R Murphy, M Naidoo*, M Shepherd, J Strydom *Waitemata District Health Board The National Institute for Health Innovation
  2. 2. NIHI mHealth research • Using expertise & evidence in behaviour change techniques • Applying to unique benefits of the technology • Conducting high quality research trials
  3. 3. Why mobile technology? • • • • • • • Increasingly omnipresent (mobile phones, tablets) Removes tyranny of time and distance Effective approach for hard-to-reach cohorts Low cost Enables changes in models of care Empowers patients Rebalances clinical patient relationship
  4. 4. mHealth: transforming healthcare delivery From provider & location-centric care to: • anywhere, anytime care • community & home • consumer access & control of health information • mobile interactivity with system • effective agent to improve health status
  5. 5. Educating Empowering Patients/ Popn helping people to live healthier lives, reducing demand for expensive resources Providers supporting clinicians working smarter, efficiency in health system
  6. 6. mHealth Interventions • Text messaging smoking cessation • Video messaging smoking cessation • Multimedia messaging depression prevention in adolescents • Text messaging / internet exercise support for cardiac patients • Text messaging weight loss programme • Text messaging brief intervention for problem alcohol drinking • Smartphone applications for data collection • Smartphone application for dietary advice • Tools & communication for people with diabetes • Text messaging for pregnant women / families
  7. 7. Conceptualisation - Evidence - Experts - Population Whittaker R, Merry S, Dorey E & Maddison R (2012): A Development and Evaluation Process for mHealth Interventions: Examples From New Zealand, Journal of Health Communication: International Perspectives, 17:sup1, 11-21 To link to this article: http://dx.doi.org/10.1080/10810730.2011.649103
  8. 8. What is the issue? • Rising prevalence of diabetes 15.8% 24,000 Waitemata residents
  9. 9. System-wide process • • • • • • • • Involve stakeholders Establish Maori Advisory Group Identify their issues and gaps Identify existing tools, review & pre-test Refine/adapt or develop new tools Pilot tools Further refinements & integration Implement & evaluate
  10. 10. What is the problem we are trying to address? • How to support & enhance self-management of diabetes to prevent/slow progression to CVD & other sequelae • Asked patients, providers, clinicians: – Where are the gaps? – What are the needs of patients? – What do primary & secondary care need in order to be able to support their patients better? – How can technology & IT – based tools help? – How can we integrate these into the system?
  11. 11. Self-management support landscape Whanau Community Population health National Regional District Locality PHO Pharmacy Patient Primary Secondary Evidence on what works: intensive, integrated into health care, involves providers, comprehensive, holistic, practical & personal advice
  12. 12. Potential tools Telemonitoring Text messaging Education programmes Smartphone apps eTherapy Video conferencing Population based registers Shared Care Plan Electronic health records Patient portals Telehealth Practice audit & improvement Smart glucometers
  13. 13. How do they address the gaps? Educating Patients Empowering Smartphone apps, smart glucometers, SMS, websites, telemonitoring, eTherapy, PHR/portals Structured communication between clinicians and patients eg. text, email, phone, web-based, video Providers Practice-based review, specialist involvement in community/primary, recalls, reminders, shared health information & care plans, video conferencing
  14. 14. Tools 1. 2. 3. 4. 5. 6. 7. Virtual Diabetes Register Shared Care Plan Primary care collaboratives Specialist team support for primary care Text messaging support Home monitoring support Smartphone apps
  15. 15. Population data for high level planning and targeting services • Virtual Diabetes Register
  16. 16. Sharing health information & care plan
  17. 17. Motivation & support for self-management • People with poor control who want extra (automated) support between visits / at home • Limited technology access • Evidence around behaviour change SMS4BG: You need to test your techniques glucose more – – – – – Motivation for good control Feeling supported & connected Education/information where appropriate Reminders about testing if desired Self-review if desired often when you are unwell and when changing meds/doses
  18. 18. SMS4BG • Maori/non-Maori versions • Options – Reminders for glucose monitoring • Graphed on patient portal – – – – Insulin Young people Smoker Specific goal for next 3 months: • Healthy eating • Physical activity • Stress & mood management • Between clinic visits (3 month blocks) Be prepared with plenty of healthy food, do the shopping when you have plenty of time to look for healthy options
  19. 19. SMS4BG Pilot study 42 people (with mean HbA1c=85) received programme for 3 months “loved it” “halved my HbA1c” “lost 7 kg” “There is constant reminder what steps to take to improve” “it works yeehaa!”
  20. 20. Intensive home monitoring support Need for a short-term structured programme for starting on insulin – Motivation & support for self-management – Clinical advice on titration – Personal communication with team Pre-testing existing hub in the home – Daily monitoring reminders & questions/responses – Structured communication with team – Issues but ¾ liked it
  21. 21. Point of purchase dietary advice FoodSwitch smartphone app & nutrient database - do we need a specific version for people with diabetes?
  22. 22. Specialist support in the community Video conferencing – Paper rounds and advice by specialists with primary care teams – Virtual clinics by specialists in primary care – Community Allied Health home visits
  23. 23. Educating Empowering Patients SMS4BG FoodSwitch SMS4BG Home monitoring SCP Virtual clinics Providers Up-skilling primary care via telehealth Decision support tools SCP Primary care data & collaborative
  24. 24. Where to? An integrated comprehensive IT-enabled system to support self-management & better control of diabetes Population-based data Primary care base Shared patient-centred plans & info Suite of patient tools to choose from
  25. 25. Acknowledgements Thank you r.whittaker@nihi.auckland.ac.nz @rawegd

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