4-C THIRD. Enhancing Care for Cardiac Patients with Diabetes Through Telehealth: Development of a Cross Cultural Intervention

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1 4-C THIRD Enhancing Care for Cardiac Patients with Diabetes Through Telehealth: Development of a Cross Cultural Intervention Chiung-Jung (Jo) Wu, RN DrHlthSc is a nursing academic at the School of Nursing, member of (IHBI), Queensland University of Technology (QUT), Brisbane, Australia. She has been awarded multiple research grants, is a reviewer of nursing/ behavioral journals, and grant applications, as well as being on the Editorial Board of International Nursing Review (official Journal of International Council of Nurses). Dr Wu teaches undergraduate students, supervises higher degree research students, has extensive clinical experience. Dr Wu is leading multidisciplinary teams investigating self-management programs for cardiac patients with diabetes, incorporating telephone, text-messaging and peer supporters in the delivery of the program, evaluating these delivery modes for transitional care and undertaking the intervention in different cultural contexts. Huei-Chuan (Christina) Sung, RN PhD Anne M Chang, RN PhD Mary Courtney, RN PhD Marilyn Ray, RN PhD CTN-A Dr. Marilyn Ray is a charter member of the International Association for Human Caring, and a Board Member, She is a nursing theorist advancing the Theory of Bureaucratic Caring. She has published the books, Transcultural caring dynamics in nursing and health care; and with Dr. Marian Turkel, Nursing, Caring, and Complexity Science: For Human-Environment Well-Being. She has been engaged in teaching, mentorship, research on organizational culture and the economics of caring and other structural components of organizational caring. She is widely published, and presents nationally and internationally on caring science and the art of caring practice in complex organizations. She mentors students, faculty and administrators at all levels of caring science scholarship and practice.

2 Enhancing care for cardiac patients with diabetes through telehealth: Development of a cross cultural intervention Research Team led by Dr Chiung Jung (Jo) Wu (QUT, Australia) Dr Christina Sung (Taiwan), Prof Anne M Chang (QUT, Australia) Prof Mary Courtney (ACU, Australia) Emeritus Prof Marilyn Ray (Florida Atlantic University USA) Copyrights Queensland University of Technology, Brisbane, Australia (2012). All rights reserved subject to the prior written permission of the copyright owner or fair dealing as permitted under the copyright law in your country. Acknowledgements This project is supported by funding from the QUT Institute of Health and Biomedical Innovation (IHBI) Human Health and Wellbeing Collaborative Research Development grant. Clinical collaborators: Australia: Royal Brisbane & Women s Hospital Mater Health Services, Brisbane; Taiwan: TzuChi Hospital This project has been registered with Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN: Background Cardiac disease and type 2 diabetes are significant global health problems 17% Australians (3.4 million) have cardiovascular diseases comorbid with type 2 diabetes [1, 2] With Western lifestyle influences, similar prevalence of these diseases are found in Australia and in Taiwan [3 5] Leads to: Mortality rate: approx 30 Australian men and women everyday) [6] Healthcare costs, e.g. higher readmission rates (22% vs. 6%) [7] Our previous studies showed positive outcomes of self management programs for cardiac patients and diabetes incorporating telehealth such as telephone and text messaging (SMS). [Wu et al. 2011, 2012] It is also important to consider the caring style [Ray 2010] 1

3 Aims To develop and test a Cardiac Diabetes Self Management Program incorporating telephone and text messaging follow up support for cardiac patients with diabetes in two different cultural contexts: Taiwan and Australia Methods Design: A randomised controlled trial with block randomisation International collaborative across cultural study Table 1: Study design 2

4 Methods Experimental group: received newly developed CDSMP + usual education provided in hospital Control group: received usual education provided in hospital Settings The study is an international collaborative project between: QUT, Royal Brisbane & Women s Hospital, Brisbane, Australia Mater Health Services, Brisbane, Australia Tzu Chi Hospital, Taiwan Sample Inclusion criteria With type 2 diabetes for over 1 year 18 years and over Admitted to CCU Able to read and speak English Have a mobile phone Exclusion criteria Unable to read and speak English Discharged home from CCU after 1 day Transferred to another hospital Hospital stay > 14 days On respiratory ventilator 3

5 Research Questions Do patients receiving the newly developed T CDSMP have: Higher self management behaviour, Greater self efficacy & knowledge, Better quality of life levels at week 4 compared to patients receiving the usual education provided? Self efficacy model adapted from McDowell et al. (2004) Our previous studies 4

6 Data analysis Preliminary results (not in IAHC conference) Summary Outcomes Challenges Prepared & presented by ( ) 5

7 References 1. Australian Institute of Health and Welfare (AIHW) (2011). Cardiovascular disease: Australian facts 2011, detail/?id= &tab=2 2. Caughey, G. E., Vitry, A. I., Gilbert, A. L., Roughead, E.E Prevalence of comorbidity of chronic diseases in Australia, BMC Public Health 8 (221) doi: / Shaw, J.E., Sicree, R.A., Zimmet, P.Z Global estimates of the prevalence of diabetes for 2010 and Diabetes Research and Clinical Practice 87, Ueshima, H., Sekikawa, A., Miura, K, et al Cardiovascular disease and risk factors in Asia: a selected review, Circulation 118, Department of Health (2011) Health and Vital Statistics, Department of Health, Taipei, Taiwan. Retrieved from: 6. Access Economics. The economics costs of a heart attack and chest pain (Acute Coronary Syndrome) June Available from: 7. Wu, C J & Chang, A.M. (2008). Audit of patients with type 2 diabetes following a critical cardiac event, International Nursing Review, 55, Vermeire. E., et al. (2005). Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus (Review). Cochrane Database of Systematic Reviews, (2), Beswick, A. D., Rees, K., West, R. R., Taylor, F. C., Burke, M., Griebash, I., et al. (2005). Improving uptake and adherence in cardiac rehabilitation: literature review. Journal of Advanced Nursing, 49(5), Wu, C J (Jo). Chang, AM., Courtney, M., Ramis, M. (2011). Using user friendly telecommunications to improve cardiac and diabetes self management program: A pilot study. Journal of Evaluation in Clinical Practice. DOI: /j x References 11. Wu, C J (Jo). Chang, AM., Courtney, M., Ramis, M. (2011). Using user friendly telecommunications to improve cardiac and diabetes self management program: A pilot study. Journal of Evaluation in Clinical Practice. DOI: /j x 12. Mistiaen, P. & Poot, E. (2006). Telephone follow up, initiate by a hospital based health professional, for postdischarge problems in patients discharge from hospital to home. Cochrane Database of Systematic Reviews, Issue 4, Art. No.: CD DOI: / pub Fjeldsoe B.S., Marshall A.L., Miller, Y.D. (2009). Behaviour change interventions delivered by mobile telephone short message service, American Journal of Preventive Medicine, 36(2), Jackson, C.L., et al. (2006). A systematic review of interactive computer assisted technology in diabetes care. Journal of General Internal Medicine, 21, Wu C J (Jo), Chang A.M., McDowell,J. (2008) Perspectives of patients with type 2 diabetes following a critical cardiac event: An interpretive approach. Journal of Clinical Nursing, 17, 5(A), Wu C J, Chang AM, McDowell J. (2009). Innovative self management program for diabetics following CCU admission, International Nursing Review, 56(3), Wu C J (Jo), Chang, AM, Courtney M, Kostner K (Jan 2012 in press) Peer supporters for cardiac patients with diabetes: a randomised controlled trial. International Nursing Review. Article first published online: 17 APR 2012 DOI: /j x 18. Wu, C J (Jo), Chang M, Courtney M, Shortridge Baggett LM, Kostner K (2011) Development and pilot test of a peer support based cardiac diabetes self management program: A study protocol /11/ Ray, M (2010) Transcultural caring dynamics in nursing and health care. Philadelphia: F.A. Davis Company. 20. Davidson, A. &Ray, M. (Eds.) (2010). Nursing, caring, complexity for human environment well being. Springer Publishing Company. 6

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