Development and evaluation of an automated telephone system for diabetes self-management

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1 Development and evaluation of an automated telephone system for diabetes self-management Dominique Bird and Brian Oldenburg, Monash University Richard Wootton, University of Queensland Robert H Friedman, Boston University, USA

2 Existing and Emerging Telecommunication Technologies (ICT) Telephone Internet (Interactive automated) telephone Computers (lap, desk and kiosk) Expert systems Wireless networks PDAs CD-ROM and DVD-ROM Smartphones Smart cards etc

3 Telehealth intervention trials currently underway in Australia Logan Healthy Living real world trial To assess the effectiveness of a telephone coaching and print delivered intervention to improve diet and physical activity in people with cancer, type 2 diabetes and hypertension Focused on low-ses communities Trials of telephone-linked care (TLC) Utilizing automated telecommunications system

4 Presentation overview Telephone Linked Care (TLC) Australian TLC Diabetes components Findings from Australian TLC development Evaluation

5 Why considering an automated interactive telephone system? Effective chronic disease prevention and management programs Multidisciplinary Long term & ongoing Available in areas with restricted access to health services Available 24/7 Automated telecommunications technology Accessible from home at any time Consistency of program delivery

6 Telephone Linked Care System: TLC Developed by Robert Friedman from Medical Information Systems Unit, Boston Medical Centre 1 PC with speech recognition and database connected to phone lines Converses over the phone by using pre-recorded messages and questions Listens to answers and records them in the database to provide tailored feedback to each user Acts as monitor, educator and coach Friedman RH et Al. Am J Hypertension. 1996; 9:

7 Australian TLC Diabetes To promote and support self-management of Type 2 diabetes Targeting essential diabetes self-care behaviours: Blood glucose testing Nutrition Physical activity Medication taking

8 TLC Diabetes Conversation Content: example of TLC promoting self-monitoring It s very important that you try to check your blood glucose more often. You set a goal with your doctor to test your blood glucose at least Individualised goal times per week. If that sounds like a lot, you could try working up to it in smaller steps. For starters, you might try testing once a day varying the time: before breakfast, lunch and dinner. Once you re used to that, you can start doing it twice a day. If you build up gradually, you ll reach your target in no time. But even if you don t, testing a few times a week is still better than no testing at all. Now, let s go on to the next part of the call.

9 TLC Diabetes Conversation Content: example of TLC promoting self-monitoring Let s talk about some of the reasons why you may not be testing your blood glucose as often as you should. I am going to list 14 common reasons why people have trouble checking their blood glucose regularly. This will help me to suggest some strategies that will help you to test more regularly. After each statement please tell me how much it applies to you. You can say Often, Sometimes, Hardly Ever, or Not Sure. Or say Repeat if you want to hear it again. OK, here is the first statement.

10 Australian TLC Diabetes Components In addition to TLC system: Case Manager: Monitors TLC calls and TLC alerts Contacts patients and health providers as appropriate Handbook: Reinforces self-management principles and educational information Offers information on local resources Glucose meter data transmitter: Transmits blood glucose readings to TLC database

11 Australian TLC Diabetes TLC (Telephone Linked Care): Educates, monitors, supports and produces alerts and reports Case Manager: monitors and triages reports and alerts Health Provider: Collaborative goal setting Self-Monitoring: e.g. Blood Glucose testing, symptoms monitoring Electronic Health Record

12 Findings from Australian TLC development: 1. Acceptability of US-designed TLC in Australia Pilot of TLC Physical Activity Pilot participants reported high satisfaction level Key learning to adapt program to Australian context: 1. Language, accent and colloquialisms 2. Socio-cultural/environmental factors 3. Health systems 4. Health guidelines Oldenburg, B., Bird D., and Friedman, R. (2005) Adaptation of an automated telephone system to promote physical activity in Australia. Ann Behav Med, 29 (Supp), S083

13 2. Transferring TLC from US to Australian context Adapting over 2,000 TLC conversation statements Review by health professionals and lay persons Amendment of scripts Creation of new scripts Recording by Australian voice actors Adapting technology

14 3. Testing of conversation scripts Quality of voice recording Accuracy of delivery according to logic Technological bugs

15 4. New device to upload blood glucose (BG) readings Directly from caller s home to TLC database Just before weekly call to TLC Diabetes Improving accuracy of TLC feedback on BG testing

16 AliveConnect transmitter with meter

17 New device to upload BG readings - AliveConnect

18 Testing of AliveConnect BG uploading 7 patients with Type 2 diabetes Uploaded BG readings daily for 5 7 days Reported high satisfaction with userfriendliness of instructions and device Made suggestions to improve instructions

19 5. Pilot of TLC system AliveConnect + TLC calls 12 individuals with Type 2 diabetes Call TLC daily for 10 days Record duration of call, comments and problems on call record card Participate in semi-structured interview to assess acceptability and usefulness

20 Evaluation: RCT of Australian TLC Diabetes Compared to Usual Care Group the TLC Diabetes Group (TLC + Usual Medical Care) will show significant improvements in: Glycaemic control Quality of life Key self-care behaviours TLC intervention will be more cost-effective

21 Summary Building an automated telehealth system is complex Transferring a behaviour change program from one culture to another is an elaborate task Key findings: Necessity to break down the development into manageable components Importance of comprehensively evaluating each component, in particular for acceptability, before launching into full implementation testing

22 Acknowledgements Funded by NHMRC, HCF, Qld Health: Investigators from 5 institutions Australian Diabetes Educators Association Roche Diagnostics Diabetes Australia - Queensland Alive Technologies Pty Ltd

23 THANK YOU CONTACT DETAILS

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