Enhancing Communication Through Technology Presented by Debbie Hollahan

Enhancing Communication Through Technology Presented by: Debbie Hollahan, RN, BHSc. N, CDE Coordinator, 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 A 1 C 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 A 1 C 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!!