Using Web-mediated Facilitation for Prevention of Illness and Promotion of Health in Patients with Chronic Diseases

1
Using Web-mediated Facilitation for Prevention
of Illness and Promotion of Health in Patients
with Chronic Diseases
Atlantic Network for Prevention Research
2005 Naomi Mensink
2
Context Principles

• Application of the principles of Health
  Informatics
• From the perspective of the user of health
  services (patient/client/resident/citizen/consumer
  )
• Focus on management of chronic conditions for
  optimum health with less patientcare provider
  face time needed
• Using the concept of most trusted information
  source

3
Agenda

• The objectives driving HealthInfoRx
• Results from research with IBD patients
• Application to Diabetes
• Future Plans

4
The Objectives Driving HealthInfoRx

• Support a proactive, self-management approach to
  health
• Provide patients with access to
• answers to frequently-asked-questions (FAQs),
• evidence-based learning resources that support
  life-long learning specific to the patient and
  the condition,
• secure communication with care providers,
• opportunities to network with others with similar
  conditions
• Most trusted source -- health professionals
  monitor and guide patients use of web-mediated,
  evidence-based information, teaching and care
  advice

5
Current Development/Research Area

• A system that allows a patient to build a
  personal health profile
• Applying clinical practice guidelines to an
  individuals specific conditions
• Self-Management Skills     - daily calendar of
  prompts
• Self-Management Knowledge     -what monitoring
  is required     -evidence for interventions by
  healthcare providers     -alignment of personal
  plan with guidelines
• based on EH Wagners model of chronic disease
  management (Wagner, 1998)

6
Research with IBD Patients

• Pilot test the concept and the processes
• HealthInfoRx was designed as a virtual clinic
  that would
• increase knowledge and comfort with
  self-management
• reduce the amount of face to face time with care
  providers when appropriate allowing increased
  face time where needed
• reduce the amount of travel required to meet with
  specialist care providers

7
(No Transcript)
8
The IBD Study Its Design

• A one-year period with 76 patients of the IBD
  clinic at Capital Health, Halifax enrolled
• Pre- and post- testing (focus groups, surveys and
  standardized questionnaires) for
• knowledge levels
• SF36 health status
• IBDQ quality of life
• satisfaction with information sources
• ability to navigate the web-site
• format of educational material
• use of various part of the web-site

9
(No Transcript)
10
Notes

• Participants were reasonable and selective in
  their contacts with health professionals using
  this medium
• Techniques for managing interface with health
  professionals
• Use of secure message exchange rather than email
• Use of an automatic form identifying general
  categories of questions and offering quick links
  to web-based resources
• Triage of messages by a clinic nurse for referral
  to the most appropriate responder

11
Application to Diabetes Management

• As part of two research initiatives, the
  principles of HealthInfoRx are being applied to
  diabetes as a chronic disease
• use web-mediated facilitation to prevent error
• recruit patients to be active participants on the
  health care team
• Patients have the strongest vested interest in
  the outcomes of their own care and case
  management.

12
Application to Diabetes Management

• Patients can learn about their chronic disease
  and through management of their own
  health-related information and understanding of
  appropriate case management, they improve the
  likelihood of
• Accurate diagnosis and appropriate choice of
  therapy
• Use of appropriate diagnostic tests
• Improved interpretation of test results
• Appropriate action on abnormal results
• Appropriate prescribing of therapies
• Appropriate dosages of medications

13

14
Methods Diabetes Study

• Patients would be able to use the web-based
  interactive system to access
• a curriculum for learning
• their personal healthcare plan for scheduling
  and managing their own health-related behavior
  and prompting their providers for necessary
  actions
• their personal health record for recording and
  monitoring their progress, with regular reviews
  to see if actions need to change.
• These resources would be available in addition to
  the support normally provided by disease-specific
  support agencies and groups.

15
Future Possibilities

• Work with currently active chronic disease
  support groups who already have a web presence to
  develop self-management modules similar to the
  one being developed for diabetes.
• Work with other care provider teams working in a
  chronic disease area to develop interactive
  processes between patients and providers
• Collaboratively developed cooperatives using this
  system of resources and interaction to improve
  population health status.

16
References

• Anderson RM, Funnell MM, Butler PM, Arnold MS,
  Fitzgerald JT, Reste CC. Patient empowerment
  results of a randomized controlled trial.
  Diabetes Care. 199518943-949.
• Baker GR, Norton PG , Flintoft V, et al. The
  Canadian Adverse Events Study the incidence of
  adverse events among hospital patients in Canada.
  CMAJ 2004 170(11)1040498. Available at
  http//www.cmaj.ca/cgi/content/full/170/11/1678
• Berg M. Patient care information systems and
  health care work A sociotechnical approach.
  International Journal of Medical Informatics
  1999 55 87-101.
• Canadian Diabetes Association Clinical Practice
  Guidelines Expert Committee. Canadian Diabetes
  Association 2003 Clinical Practice Guidelines for
  the Prevention and Management of Diabetes in
  Canada. Can J Diabetes. 200327(suppl 2).
• Eaden JA, Abrams K, Mayberry JF. The Crohns and
  Colitis Knowledge score a test for measruing
  patient knowledge in Inflammatory Bowel Disease.
  Am J Gastronenterol 1999 12 3560-3566.
• Gilliam AD, Speake WJ, Scholefield JH, Beckingham
  IJ. Finding the best from the rest evaluation of
  the quality of patient information on the
  internet. Annals of the Royal College of Surgeons
  of England 2003 85(1) 44-46.
• HealthInfoRx http//www.healthinforx.ca/
• Kwon, HS, Cho JH, Kim, HS et. al. Establishment
  of blood glucose monitoring system using the
  intenet. Diabetes Care 2004Institute of Medicine.
  Crossing the Quality Chasm A New Health System
  for the 21st Century. Washington DC National
  Academy Press 2003. 27(2) 478-483.

17
References

• Liederman EM, Morefield CS. Web messaging A new
  tool for patient-physician communication. JAMIA
  2003 10(3) 260-270.
• Lorig K, Prohaska TR, Harris M, Gonzalez VM, et
  al. Patient education a practical approach. 3rd
  edition. Thousands Oaks, CA Sage Publications
  2001.pp.21-55.
• Meigs JB, Cagliero E, Dudey A, et. al. A
  controlled trial of web-based diabetes disease
  management. Diabetes Care 2003 26 750-757.
• Tang PC, Newcomb C. Informing patients a guide
  for providing patient health information. JAMIA.
  1998 Nov/Dec 5(6)563-70
• Timmons S. The potential contribution of social
  science to information technology implementation
  in healthcare. Computers in Nursing 2001 20(2)
  74-78.
• Wagner EH. Chronic disease management What will
  it take to improve care for chronic illness?
  Effective Clinical Practice. 199812-4.
• Wagner EH, Austin BT, Davis C, Hindmarsh M,
  Schaefer J, Bonomi A. Improving chronic illness
  care translating evidence into action. Health
  Affairs 2001 20(6) 64-78.
• White CB, Moyer, CA, Stern DT, Katz SJ. A content
  analysis of e-mail communication between patients
  and their providers Patients get the message.
  JAMIA 11(3) 260-67.

18
Thank you

• Any
• Questions?