Evaluation of the use of an interactive web-based support program for optimizing the management of Diabetes Mellitus

Medicine 2.0

Background: The introduction of the Internet into medical practice as an information-sharing and communication medium has brought about many opportunities for the management of chronic care. Research has shown that teleconsultation for example is a practical, cost-effective, and reliable way of delivering a worthwhile health care service to diabetics [1,2]. Medicinfo, a leading e-health company in the Netherlands, used this knowledge to develop an interactive web-based diabetes self-management support program, called the Diabetescoach: a low-tech solution for a large group of diabetes patients (type II). The Diabetescoach is aimed at improving access to care by facilitating easier, time-efficient communication between patients and nurses, and at facilitating self-care via education, monitoring, and entertainment for persuading individuals to make life-style changes. A Diabetescoach pilot project runs within three primary care practices (pilot group: 50 patients, 6 nurses). Objective: To assess the added value of the Diabetescoach as a supplement on regular diabetes care. We focused on patient needs, expectations, motivations, and experiences with electronic care via the Diabetescoach. We also assessed nurses' experiences. Methods: We conducted usability tests combined with in-depth interviews with 20 patients and 5 nurses to assess patients' and nurses' experiences with electronic care. Log-files registered system usage and content of patient-caregiver interaction. Via a validated questionnaire we gathered information about patient characteristics, like age, gender, education, diabetes duration, quality of life, diabetes knowledge, and diabetes self-efficacy. Results: Mean age of the participating patients (n=50) was 62 years, with a minimum age of 43 years and a maximum of 80 years. Log-files showed that 80% (n=40) of the total pilot group used the Diabetescoach regularly. Usability tests and interviews revealed that the Diabetescoach is seen as a useful and worthwhile supplement on regular diabetes care. It proved to be a powerful instrument to learn about the disease and about disease control. Usability tests also functioned as a powerful training method; participants were more skilled and more motivated to use the Diabetescoach afterwards. Patients were particularly interested in telemonitoring and the mail contact with their caregiver. Nurses often initiated mail contact; they give feedback on measurements, lifestyle, and make compliments on patients' healthy behaviour. Patients ask for information about nutrition, for personal advice on health issues, they use mail for changing appointments, and for expression of emotions (worries, appreciation about care delivery). Patients like to receive feedback and compliments by mail; it motivates them to adapt to healthy behaviour. Conclusion: The Diabetescoach supports patients in the control of their own care. Patients are particularly enthusiastic about the possibility to mail with their nurse. However, not all patients were motivated or skilled enough to use the Diabetescoach. For electronic care applications, it is important to give adequate training and to explore who suites which technology best and what changes are necessary to reach non-users or drop-outs. Innovations in health care diffuse more rapidly when technology is used that is simple to use, affective aimed at expression of emotions and useful; taking into account the expectations and needs of end-users [3]. 1. Verhoeven F, van Gemert-Pijnen L, Dijkstra K, Nijland N, Seydel E, Steehouder M. The contribution of teleconsultation and videoconferencing to diabetes care: a systematic literature review. J Med Internet Res 2007 Dec 14;9(5):e37. 2. Glasgow RE, Boles SM, McKay HG, Feil EG, Barrera M Jr. The D-Net diabetes self-management program: long-term implementation, outcomes, and generalization results. Prev Med 2003 Apr;36(4):410-9. 3. Cain M, Mittman R (2002). Diffusion of...