Presented by Robyn Whittaker National Institute for Health Innovation, University of Auckland

1. A comprehensive approach
to diabetes selfmanagement support
R Whittaker, D Bramley*, K Carter, R Cutfield*, R
Dobson, E Dorey, H Eyles, C McNamara*, R Murphy, M
Naidoo*, M Shepherd, J Strydom
*Waitemata District Health Board
The National Institute
for Health Innovation

2. NIHI mHealth research
• Using expertise & evidence in
behaviour change techniques
• Applying to unique benefits of
the technology
• Conducting high quality research
trials

3. Why mobile technology?
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Increasingly omnipresent (mobile phones, tablets)
Removes tyranny of time and distance
Effective approach for hard-to-reach cohorts
Low cost
Enables changes in models of care
Empowers patients
Rebalances clinical patient relationship

4. mHealth:
transforming healthcare delivery
From provider & location-centric care to:
• anywhere, anytime care
• community & home
• consumer access & control of health
information
• mobile interactivity with system
• effective agent to improve health status

5. Educating
Empowering
Patients/
Popn
helping people to live healthier lives, reducing
demand for expensive resources
Providers
supporting clinicians working smarter, efficiency
in health system

6. mHealth Interventions
• Text messaging smoking cessation
• Video messaging smoking cessation
• Multimedia messaging depression prevention in
adolescents
• Text messaging / internet exercise support for
cardiac patients
• Text messaging weight loss programme
• Text messaging brief intervention for problem
alcohol drinking
• Smartphone applications for data collection
• Smartphone application for dietary advice
• Tools & communication for people with
diabetes
• Text messaging for pregnant women / families

7. Conceptualisation
- Evidence
- Experts
- Population
Whittaker R, Merry S, Dorey E & Maddison R (2012): A Development and Evaluation
Process for mHealth Interventions: Examples From New Zealand, Journal of Health
Communication: International Perspectives, 17:sup1, 11-21
To link to this article: http://dx.doi.org/10.1080/10810730.2011.649103

8. What is the issue?
• Rising prevalence of diabetes
15.8%
24,000 Waitemata
residents

9. System-wide process
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Involve stakeholders
Establish Maori Advisory Group
Identify their issues and gaps
Identify existing tools, review & pre-test
Refine/adapt or develop new tools
Pilot tools
Further refinements & integration
Implement & evaluate

10. What is the problem we are trying
to address?
• How to support & enhance self-management of
diabetes to prevent/slow progression to CVD &
other sequelae
• Asked patients, providers, clinicians:
– Where are the gaps?
– What are the needs of patients?
– What do primary & secondary care need in order to
be able to support their patients better?
– How can technology & IT – based tools help?
– How can we integrate these into the system?

11. Self-management support landscape
Whanau
Community
Population
health
National
Regional
District
Locality
PHO
Pharmacy
Patient
Primary
Secondary
Evidence on what works: intensive, integrated into health care,
involves providers, comprehensive, holistic, practical & personal
advice

12. Potential tools
Telemonitoring
Text messaging
Education programmes
Smartphone apps
eTherapy
Video conferencing
Population based registers
Shared Care Plan
Electronic health records
Patient portals
Telehealth
Practice audit & improvement
Smart glucometers

13. How do they address the gaps?
Educating
Patients
Empowering
Smartphone apps, smart glucometers, SMS,
websites, telemonitoring, eTherapy, PHR/portals
Structured communication between clinicians and
patients eg. text, email, phone, web-based, video
Providers
Practice-based review, specialist involvement in
community/primary, recalls, reminders, shared
health information & care plans, video
conferencing

14. Tools
1.
2.
3.
4.
5.
6.
7.
Virtual Diabetes Register
Shared Care Plan
Primary care collaboratives
Specialist team support for primary care
Text messaging support
Home monitoring support
Smartphone apps

15. Population data for
high level planning
and targeting
services
• Virtual Diabetes
Register

16. Sharing health information & care plan

17. Motivation & support for self-management
• People with poor control who want extra
(automated) support between visits / at home
• Limited technology access
• Evidence around behaviour change
SMS4BG: You
need to test your
techniques
glucose more
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Motivation for good control
Feeling supported & connected
Education/information where appropriate
Reminders about testing if desired
Self-review if desired
often when you
are unwell and
when changing
meds/doses

18. SMS4BG
• Maori/non-Maori versions
• Options
– Reminders for glucose monitoring
• Graphed on patient portal
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Insulin
Young people
Smoker
Specific goal for next 3 months:
• Healthy eating
• Physical activity
• Stress & mood management
• Between clinic visits (3 month blocks)
Be prepared with
plenty of healthy
food, do the
shopping when
you have plenty
of time to look for
healthy options

19. SMS4BG Pilot study
42 people (with mean HbA1c=85) received
programme for 3 months
“loved it”
“halved my HbA1c”
“lost 7 kg”
“There is constant reminder what steps to take to improve”
“it works yeehaa!”

20. Intensive home monitoring support
Need for a short-term structured programme for
starting on insulin
– Motivation & support for self-management
– Clinical advice on titration
– Personal communication with team
Pre-testing existing hub in the home
– Daily monitoring reminders & questions/responses
– Structured communication with team
– Issues but ¾ liked it

21. Point of purchase dietary advice
FoodSwitch
smartphone app
& nutrient
database
- do we need a
specific version
for people with
diabetes?

22. Specialist support in the community
Video conferencing
– Paper rounds and advice by specialists with primary
care teams
– Virtual clinics by specialists in primary care
– Community Allied Health home visits

23. Educating
Empowering
Patients
SMS4BG
FoodSwitch
SMS4BG
Home monitoring
SCP
Virtual clinics
Providers
Up-skilling primary care
via telehealth
Decision support tools
SCP
Primary care data &
collaborative

24. Where to?
An integrated comprehensive IT-enabled system
to support self-management & better control of
diabetes
Population-based data
Primary care base
Shared patient-centred plans & info
Suite of patient tools to choose from

25. Acknowledgements
Thank you
r.whittaker@nihi.auckland.ac.nz
@rawegd