mHealth Helps Patients Take Control of Their Diabetes

NEW ORLEANS — An estimated 91% of U.S. adults own a cell phone and 56% have smartphones. To take advantage of these popular technologies to improve diabetes outcomes, researchers are promoting an innovative program that uses nurse health coaching with motivational interviewing techniques as well as wireless sensor and mobile health (mHealth) technology.

“Improvements in diabetes management can occur when patients are engaged in setting realistic, attainable and measurable goals which are tracked with mHealth-enabled technology and integrated into the electronic health record,” said Heather Young, PhD, RN, who is a professor and Assistant Vice Chancellor for Nursing at the University of California, Davis in Sacramento.

“This project is funded by PCORI, the Patient Centered Outcomes Research Institute, which is a relatively new federal funding agency that puts the patient at the center of care and supports investigators who are committed to patient engagement in improving health care delivery to achieve outcomes valued by patients.”

During her presentation at AADE 2015, the annual meeting of the American Association of Diabetes Educators, Young provided a framework for an intervention that engages patients in prioritizing health behavior changes and developing a plan to improve their outcomes. 

“It includes perspectives that patients have shared about what they want from technology that tracks health indicators and how they prefer that data to be used in clinical conversations,” Young told Endocrinology Advisor.

PCORI was established as a provision of the Affordable Care Act (ACA), and the first research projects began in December 2012. It is funded by the federal general fund and fees assessed on Medicare and private insurers. Young said $3.5 billion is expected in funding for PCORI through 2019 at about $650 million per year.

“This project is novel because it brings together mHealth devices/apps and clinical care, providing a common platform for patients and clinicians to share as they collaborate to manage diabetes. It is an example of the kind of research that PCORI funds,” said Young.

Her presentation featured a peek at a partnership between a researcher and a patient in designing and implementing a large study aimed at changing the conversation about health between patients and providers with the aid of mHealth technology.

Maria Ibarra, a member of the patient advisory board for the project, shared how her participation in research that enabled her to use her own data to evaluate her responses to lifestyle changes made a difference in the level of control of her diabetes.

Young discussed the P²E²T² Program, which is an innovative program that employs nurse health coaching, motivational interviewing techniques and mHealth technology.

This program uses a platform that accepts patient-generated data from sensors. It also explores patient preferences for use of technology in health care and involves a conference call with a nurse coach during which the patient establishes his or her priority health issues and desired goals. An in-person technology meeting, orientation and training, five bi-weekly support calls and a review of progress are also included.

The P²E²T² Program demonstrates that the data platform should be visually concise, intuitive and meaningful so that patients and providers can work together to promote health behavior changes through goal setting.

Today, diabetes is a chronic disease that affects one in every two adults in the U.S., and it now surpasses communicable diseases in prevalence globally, according to Young. She said modifiable behavioral risk factors (i.e., physical inactivity, poor eating and sleep habits, obesity and smoking) all can be addressed using this new approach.

It is hoped that diabetes outcomes can be improved by motivational interviewing, support with behavioral changes and tools for problem solving, she noted.

Young said issues that have to be addressed include compatibility, trust, reliability, functionality, integration and customization so that data are shared only with certain people. She also presented examples of information that could be displayed on a shared dashboard, such as goals like taking more than 10,000 steps per day, consuming less than 2,000 calories 6 days per week and climbing at least 10 flights of stairs every day.

“By creating a dashboard that summarizes patient goals, progress and tips that enhance health behavior, the conversation can change to focus on health,” said Young.

Reference

1. Young H. W17 – Advancing Diabetes Health Through Research: Opportunities with PCORI Funding. Presented at: AADE 2015; Aug. 5-8, 2015; New Orleans.