Evaluation of information and communication technology platforms to improve self-management of chronic disease

Abstract

One of the major epidemiologic trends of the current century is the rise of chronic diseases in Australia and globally. Increasing prevalence of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) is placing enormous financial and societal burden on the economy of many countries. To address the spiralling demand on health service resources, there is an urgent need for alternative, affordable strategies to support the management of these diseases effectively in the community. Historically healthcare systems were designed to manage acute illness, episodically. However, today more than 70% of global health budget expenditure is being directed towards the management of patients with chronic diseases, often with multiple co-morbidities. National and international attention is increasingly being focussed on utilising the advances in information and communication technologies (ICT), to design and develop new platforms for chronic disease management. These include strategies for supporting self-management of chronic conditions and remote monitoring of people’s health in their own homes. The aim of this doctoral research was to evaluate the effectiveness and implementation of a home-based cardiac rehabilitation (CR) program, as well as the implementation of a T2DM self-management intervention. These two programs utilised different technology platforms and were designed to help people more effectively self-manage CVD and T2DM respectively. The Care Assessment Platform (CAP) model was the first to employ new generation smartphones, mobile applications and the Internet to deliver the major components of CR at home. To validate the CAP model for its capacity to improve CR participation rates and demonstrate health benefits similar to that of traditional centre-based programs (TCR), this thesis undertook a randomised controlled trial (RCT). The results of the RCT demonstrated CAP CR to deliver health outcomes similar to that of TCR and to significantly improve uptake, adherence and completion rates. Furthermore, using Process Evaluation methods to explore the potential of implementing CAP CR in clinical practice, results showed that it is an accessible and acceptable option for delivering CR for individuals that are not willing or able to attend TCR. Diabetes self-management has been identified as an essential element of diabetes management. Suboptimal management of T2DM increases the risk of costly and debilitating diabetes-related complications. The Australian Telephone-Linked Care (TLC) Diabetes program is an automated interactive and conversational intervention which uses voice recognition to engage and support individuals living with T2DM to better self-manage their condition. An earlier study reported that participants receiving the TLC Diabetes program showed a significant decrease in glycaemic control measured with HbA1c and also a significant improvement in the mental component of a health-related quality of life. This thesis, through Process Evaluation of the intervention, explored the feasibility of implementing such a program in real world conditions. The TLC Diabetes program demonstrated very high reach with individuals at risk of diabetes complications with a good level of implementation fidelity, program adoption and positive user perceptions. TLC Diabetes shows potential to provide an effective, convenient, easily accessible, and scalable approach for improving T2DM self-management. In conclusion, this thesis explored the delivery of two different technology-based strategies to provide resources and supports for improving self-management of patients living with CVD (CAP CR) and T2DM (TLC Diabetes). Both programs have shown the potential for expanding health service delivery, from traditionally delivered face to face encounters, to the patient’s home and community. If properly developed, implemented and evaluated, ICT platforms such as these have excellent potential to support and improve the self-management of chronic disease. Exploiting the different mechanisms and/or components of delivery offered by CAP and TLC Diabetes, could lead to improvement in self-management also for other chronic conditions