CLOUD COMPUTING FOR IMPLEMENTING M HEALTH IN LOW INCOME COUNTRIES

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1 CLOUD COMPUTING FOR IMPLEMENTING M HEALTH IN LOW INCOME COUNTRIES John D. Piette, Ph.D., Director Program on Quality Improvement for Complex Chronic Conditions Associate Director for Global Health Communications Ann Arbor VA and the University of Michigan Center for Global Health

2 The Fundamental Problem Many patients need much more assistance with self management than can ever be realistically delivered during standard outpatient encounters.

3 Communication Links That Can Be Leveraged to Improve Chronic IllnessCare Other Patients Informal Caregivers Patient Care Managers Primary Care Providers Pharmacists

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6 Why focus on telehealth?

7 Reason #1: Telephone care improves outcomes

8 The contribution of a telephone support program for improving the self-care of people with type 2 diabetes ange I, et al. Efecto de un modelo de apoyo telefónico en el auto-manejo y ntro metabólico de la Diabetes tipo 2, en un Centro de Atención Primaria, antiago Chile. Revista Medica de Chile 2010; 138:

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11 Reason #2: Everybody has a cell phone

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14 Findings from Honduras Cell Phone Any Phone Voic SMS Primary Secondary > Secondary Piette JD, et al. Access to mobile communication technology and willingness to participate in automated telemedicine calls among chronically ill patients in Honduras. Telemed J E Health 2010;16(10):

15 Interest in Receiving Self Care Support via IVR Health status monitoring Mental health support Self care education Rx adherence support Visit reminders Piette JD, et al. Access to mobile communication technology and willingness to participate in automated telemedicine calls among chronically ill patients in Honduras. Telemed J E Health 2010;16(10):

16 Reason #3: Global health initiatives are focusing on cell phones

17 The CarePartner Program

18 Un modelo de computación en nubes para apoyar la telemedicina atravez de fronteras nacionales

19 Pilot Study Design 85 patients with diabetes enrolled in clinic Weekly IVR monitoring and behavior change calls sent from Michigan Baseline and follow up surveys + A1c testing Piette JD, et al. Development and pilot testing of a cloud computing model for delivering between visit support for chronic illness care in developing countries. American Journal of Preventive Medicine, in press.

20 What have we learned? Nearly all eligible patients enroll Mean A1c levels decreased from 10.0% to 8.9% (p<.01) over six weeks Piette JD, et al. Development and pilot testing of a cloud computing model for delivering between visit support for chronic illness care in developing countries. American Journal of Preventive Medicine, in press.

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22 Self reported outcomes 83% reported that the IVR calls were easy to use 86% reported that the service provided useful information for managing their diabetes 70% reported that the service helped them manage their diabetes a great deal 92% said that they definitely would use the service again if it were available in the clinic

23 Percentage of Patients Reporting an Improvement as a Result of Participating in the CarePartner Program Asking my doctor about my medication Tlki Talking with my doctor about tdiabetes Talking with family about my diabetes Foot care Treating high blood sugar levels Treating low blood sugar levels Medication adherence Blood glucose control General health Piette JD, et al. Development and pilot testing of a cloud computing model for delivering betweenvisit support for chronic illness care in developing countries. American Journal of Preventive Medicine, in press.

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27 Thank you

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31 Feedback from Patients Estoy muy contento ha sido una jornada positiva. Me hace pensar mucho másen mi enfermedad d y lo que tengo que hacer. Me siento bendecida por participar, porque me anima a autocuidarme mejor.

32 Wu L, et al. Telephone follow up to improve glycaemic control in patients with type 2 diabetes: systematic review and meta analysis of controlled trials. Diabetic Medicine, 2010 Nov;27(11):

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