Enhancing Communication Through Technology

Presented by: Debbie Hollahan, RN, BHScN, CDECoordinator, 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!!