Telemedicine and group programmes for chronic diseases
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Telemedicine and Group Programmes for chronic diseases. Dr Elsie Hui, FRCP Division of Geriatrics, CUHK Community Geriatric Assessment Team, Shatin Hospital.

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Telemedicine and group programmes for chronic diseases l.jpg

Telemedicine and Group Programmes for chronic diseases

Dr Elsie Hui, FRCP

Division of Geriatrics, CUHK

Community Geriatric Assessment Team,

Shatin Hospital


Slide2 l.jpg

Telemedicine is the use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

Telemedicine includes consultative, diagnostic, and treatment services.


Telemedicine telegeriatrics what is it and why l.jpg
Telemedicine (telegeriatrics) – from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care. what is it and why?


Tele geriatrics in residential care home setting l.jpg
Tele-geriatrics in residential care home setting from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

  • Direct care

    • Physician (geriatrician, primary care)

    • Geriatric nursing

    • physiotherapy & occupational therapy

    • podiatry

  • Specialist consultation

    • Dermatology

    • Psychiatry

    • Others (neurology, radiology ….)


Our history l.jpg
Our History from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

  • 1998 – 99

    Pilot study

    • SAGE Kwan Fong Nim Chee Care & Attention Home in Shatin

    • Medical, nursing, psychiatry, PT, OT, podiatry, dermatology

  • Extension of telemedicine network

    • To other local residential care homes for elderly (RCHEs)

    • To other hospitals in New Territories and their local RCHEs

    • To a Home Care service provider

  • 2003 - 04

    Community rehabilitation programmes

    • DM, OA, CVA, dementia, incontinence


Nte geriatric service network l.jpg

古洞 from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

廣福道

Nam

Fong

Cambridge

石湖墟

Cambridge

直街

Oi Kwan

Caritas

TPH

FWH C&A

NDH

AHNH

(COST Office)

(COST Office)

PWH

CUHK

SH x 2 stations

(COST & 8/F)

Kwan

Fong

積存街

C&A

Cambridge

Caritas C&A

花園城

HCHW

Cambridge

ELCHK

ELCHK

ELCHK

ME

DE

DECL

瀝源

秦石

馬鞍山

NTE Geriatric Service Network

  • hospitals

  • residential care homes

  • social centres

  • Broadband or ISDN (remote areas)

  • Multi-point Videoconferencing machines

    Also capable of connecting to anywhere in the world with an IP address and VC machine (386kbs)


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Shatin Hospital from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

Telehealth headquarters

ELCHK Social Services Network in Shatin

A

B

C

D

E

Day Care

HomeHelp

Community Clinic

Social Centre

Home Help

Social Centre

Day Care

Social Centre

Community Clinic

Social Centre


Videoconferencing hardware l.jpg

Tandberg 880 from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

(HKD 110 000)

Shatin Hospital

Norway

768kbps (IP/ ISDN)

Multi-point (max 4)

max 4 video outputs

72o wide field of view

Polycom ViewStation FX

(HKD 75 000)

Hospital and remote sites

USA

512kbps (IP/ISDN)

Multi-point (max 4)

max 4 video outputs

48o field of view

Videoconferencing Hardware


Slide9 l.jpg

Video conferencing link from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

Broadband

Network

1.5Mbps

1.5Mbps

Telemed Fibre IP Link

Telemed Fibre IP Link

C&A Home /

Community centre

Shatin Hospital


Pilot study l.jpg

Intervention from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

Shatin CGAT and a local Care & Attention home were linked via teleconferencing.

Services provided via telemedicine wherever possible.

Face-to-face visits were conducted if telemedicine inadequate for patient management.

Outcomes

Feasibility

Costs

Services provided & limitations

User satisfaction

Pilot study


Geriatrician l.jpg
Geriatrician from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

  • Follow-up of old cases

  • Triaging urgent medical problems

  • Saves time and increases productivity

  • Reduced unnecessary A&E visits by 10%

  • Reduced acute hospital admissions by 11% over 1 year

  • Limitations - new patients, chest auscultation


Nurse l.jpg
Nurse from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

  • Assessment

    • swallowing test

    • Wounds

    • placement

  • Educate patients and carers

    • use of inhaler,

    • checking blood sugar

  • Act as liaison between in-patient service and residential care home

  • More frequent review

  • Facilitate earlier discharge

  • Limitations - complex dressing procedures, clients with communication problems


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Physiotherapist from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

Screening new cases

Reduces waiting time and shortens follow-up intervals

Nursing home staff able to facilitate assessment and supervise rehabilitation

Limitations

patients with severe communication difficulties, examination e.g. auscultation, neurological, musculoskeletal

specialized treatment modalities e.g. TENS, manual techniques

Occupational Therapist

Useful for screening - better prepared for site visit, reduces inappropriate referrals

Reduces waiting time and shortens follow-up intervals

Closer monitoring

Limitations

assessing range of movement

activities of daily living in real life situation

environmental barriers

prescription of splints, wheelchairs and pressure garments


Podiatrist l.jpg
Podiatrist from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

  • Foot screening - nails, between toes, heels

  • Assessment of wounds, footwear, gait

  • Advise staff and patients on dressing techniques and foot protection

  • Triaging referrals according to urgency

  • Allows earlier discharge from hospital

  • Limitations - cannot perform full neurological or vascular assessment


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Telemedicine is Cheaper from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.


User satisfaction l.jpg
User satisfaction from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

  • Patients - depending on discipline, 82% to 95% were satisfied with telemedicine.

  • Nursing home staff - system was user-friendly, boosted confidence, enhanced support from hospital services.


Conclusions l.jpg
Conclusions from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

  • Telemedicine is an acceptable and useful adjunct (but doesn’t replace) to conventional outreach services.

  • It enhances the geriatric outreach team’s efficiency and improves support to nursing home residents.

  • Costs can be off-set by involving more disciplines, linking up with more homes and extending hours of service.


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Latest accessories – plug & play from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

Mobile video cart

digital camera

electronic stethoscope


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Telegeriatrics publications from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

Hui E et al. Telemedicine: A pilot study in nursing home residents. Gerontology 2001;47:82-87.

Chan WM et al. The role of telenursing in the provision of geriatric outreach services to residential homes in Hong Kong. J Telemed Telecare 2001;7:38-46.

Hui E, Woo J. Telehealth for older patients: the Hong Kong experience. J Telemed Telecare 2002;8(suppl.3):S3:39-41.

Tang WK et al. Telepsychiatry in psychogeriatric service: a pilot study. Int J Geriatr Psychiatry 2001;16:88-93.

Corcoran H et al. The acceptability of telemedicine for podiatric intervention in a residential home for the elderly. J Telemed Telecare. 2003;9(3):146-9.


Management of chronic diseases in the community l.jpg

Management of chronic diseases from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.in the community


Chronic disease group programmes l.jpg

Chronic conditions from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

Diabetes mellitus

Chronic obstructive airway disease

Heart failure

Fall prevention

Dementia

Osteoarthritis

Stroke

Incontinence

Content

group format

exercise

education

discussion

peer support

Outcomes

objective

subjective

Qualitative (focus groups)

face-to-face or via teleconferencing

Role of lay personnel

staff of social centres

volunteers

patients

Chronic disease group programmes


Program content l.jpg
Program Content from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

Patient

Education

disease management

Psychosocial

intervention

focus group

peer support

Exercises &

Games


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Features: from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

8 sessions

1 two-hr session / week

6-8 patients / group

1-2 facilitators (non-professional)

Subjects

Diagnosed DM

> 60 yrs

Community-dwelling

Setting

Community centres for elders

ELCHK in Shatin

3 core components

Education

Related to DM

Self-efficacy

Exercise

Aerobic and resistance

Group & home exercise

Psychosocial interventions

Share experiences & problems

Find solutions as a group

Peer support

A community model for care of older persons with diabetes mellitus


Exercise training l.jpg
Exercise training from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

30 minute-exercise session

starting with a 5-minute warm up

ending with a 5-minute cool down or progressive muscle relaxation training.

10-minute resistance

training using elastic tubing

(Theraband®)

followed by a 10-minute aerobic dance


Slide26 l.jpg

Outcome measures: from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

QOL

Diabetes quality of life questionnaire

SF-36

DM knowledge test

24-hours dietary recall

Body mass index

Blood sugar & HbA1c level


Key findings l.jpg
Key Findings from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

Significant changes (improvement) were observed in the following outcomes:

  • Diabetes Knowledge Test

  • Mean post-prandial blood glucose

  • HbA1c

  • Blood pressure

  • Exercise habit

  • QOL

    • Diabetes QOL questionnaire

    • SF-36


Falls management exercise program fame l.jpg

Features from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

36 weekly sessions

1 hr / session

4 – 8 subjects / group

1 therapist + 1 assistant

Subjects

Age ≥ 65 yrs

Hx of ≥ 1 fall

Able to walk ± aids

living in community

Setting

Community centres for elders

SAGE in Shatin

Shatin Hospital

Falls Management Exercise Program (FaME)


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Programme structure: from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

Wk 1 – 11: Skilling up

Wk 11 – 33: Training gain

Wk 34 – 36: Maintaining the gains

Outcomes:

Any falls during study period

Berg’s Balance Score

6 Minute Walk Test

ADL

Barthel

IADL


Conclusions30 l.jpg
Conclusions from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

  • Community-based group rehabilitation programs incorporating exercise prescription, education and peer support can improve patients’ physical and psychological outcomes in various common chronic diseases.

  • The programs should be part of a comprehensive care package offered to patients with chronic diseases.

  • Community centres for older persons are the ideal location for running these programs.


Community programmes publications l.jpg
Community programmes - Publications from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

CHF

Hui E, Yang H, Chan LS, et al. A community model of group rehabilitation for older patients with chronic heart failure: A pilot study. Disabil Rehabil 2006;28(23):1491-1497.

COPD

Woo J, Chan W, Yeung F, et a;. A community model of group therapy for the older patients with chronic obstructive pulmonary disease: a pilot study. J Eval Clin Pract 2006;12(5):523-531.

Telemedicine in rehabilitation

Elsie Hui. In Teleneurology, 2005; Royal Society of Medicine Press Ltd. Eds.Richard Wootton & Victor Patterson

DM

Chan WM, Woo J, Hui E et al. A Community model for care of elderly people with diabetes via telemedicine. Applied Nursing Research 2005;18:77-81

OA

Wong YK, Hui E, Woo J. A community-based exercise programme for older persons with knee pain using telemedicine. J Telemed telecare 2005;11:310-315

Stroke

JCK Lai, J Woo, E Hui, W M Chan. Telerehabilitation – a new model for community based stroke rehabilitation. J Telemed Telecare 2004;10:199-205

Dementia

Poon P, Hui E, Dai D, et al. Cognitive intervention for community-dwelling older persons with memory problems: telemedicine versus face-to-face treatment. Int J Geriatr Psychiatry 2005;20:285-286.

Urinary incontinence

Hui E, Lee PSC, Woo J. Management of urinary incontinence in older women using videoconferencing versus conventional management: a randomised controlled trial. J Telemed Telecare 2006;12:343-347


Chronic disease self management programme cdsmp l.jpg

Chronic Disease Self-Management Programme (CDSMP) from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.


What is chronic disease self management l.jpg
What is Chronic Disease Self-management? from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

In the Chronic Care Model:

  • Self-management involves (the person with chronic disease) engaging in activities that:

    • Protect and promote health

    • Monitor the symptoms and signs of illness

    • Manage the impacts of illness on functioning, emotions and interpersonal relationships

    • Promote adherence to treatment regimes

      Von Kroff et al., Ann Intern Med 1997;127(12):1097-1102.


The stanford cdsmp story l.jpg
The Stanford CDSMP story from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

  • Stanford University School of Medicine / Patient Education Research Centre

    • Kate Lorig, H Holman, D Sobel

    • Started in 1980s as Arthritis SMP

  • Program content

    • promoting Self-efficacy

    • developed from patient focus groups

  • Features of CDSMP

    • Group format (up to 15)

    • Interactive

    • 2 group leaders

    • Promote self-efficacy

      • Action plan

      • Problem-solving

      • Sharing

    • Modeling

      • Patients volunteer as leaders

    • Re-interpreting symptoms

    • Persuasion


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  • The definitive study from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.Lorig KR et al., Medical Care 1999;37(1):5-14.

    • 1000 patients with chronic diseases

      • Heart disease, lung disease, stroke, arthritis

    • completed CDSMP

    • Followed-up for 3 years

    • Improvements in

      • Self-efficacy

      • Health status

      • Health care utilization

      • Self-management behaviours

  • Extended to other countries

    • Canada, Europe, Australia

    • Asia

      • China, HKSAR, Taiwan, Singapore, Japan

  • Internet version

  • Generic vs. disease specific

    • DM, Back pain, AIDS

  • Leaders movement

    • Lay leaders

    • Master trainers


What is special about the cadenza community project cdsmp l.jpg
What is special about the Cadenza from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.Community Project: CDSMP?

  • To train up a group of lay leaders as the future driving force of the CDSMP movement.

  • To demonstrate that lay leaders are just as effective as professionals (e.g. social and health care workers) in leading CDSMP and achieving the desired outcomes.

  • To develop a CDSMP delivery model best suited for Hong Kong elders, and to pave the way for a territory-wide movement.


Progress of cadenza community project cdsmp l.jpg
Progress of Cadenza from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.Community Project: CDSMP

  • Commenced December 2007

  • Recruited and trained 43 elder Lay Leaders

  • 115 subjects completed the CDSMP

  • Evaluation still under way

    • Compare outcomes between intervention (attended CDSMP) and control groups at 6 months

    • Compare outcomes of groups led by elder Lay Leaders versus staff (social workers)

    • Focus groups


Summary l.jpg
Summary from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

  • In additional to conventional models of health care delivery, innovative ways to provide health care should be explored and evaluated.

  • Some of these innovations were introduced in this talk.

  • We are grateful to our visionary sponsors who helped us realize our dreams.


Thank you l.jpg

Thank you from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.

[email protected]


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