Remote Monitoring of Diabetes not so Remote

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telstra-health-my-care-manager-160415Each morning Mavis knows the routine, she weighs herself, checks her blood pressure, pulse, oxygen saturation then blood glucose levels.  All of this data is seamlessly uploaded to the screen in front of her and securely transmitted to a central location and checked by one of the nurses shortly after it is entered. Mavis has diabetes, chronic obstructive pulmonary disease, hypertension with early signs of dementia but is trying to stay in her home as long as possible.

Mavis may receive a phone call if one of her levels is out of her target range set by her GP. Sometimes when Mavis has had low blood glucose for example, they have called her via the video conferencing facility on the unit to have a chat about her treatment of the hypoglycaemic episode as well as check that she is ok. This telehealth consultation also provides opportunistic education, reinforcing self management practices when they matter most.

Mavis with all of her information uploaded, swipes across the screen to see the list of her morning medications. She takes these from her cabinet, swallows them with a glass of water and then self administers her insulin, she then taps the screen again acknowledging that her mane medication regimen has been followed. She noticed however whilst taking her tablets that her Metformin was running low. Again on the screen, she touches the appropriate box and selects Metformin from the list and the script is automatically filled and ready for her to pick up at her selected pharmacy later that day. With an estimated 50% of medications not taken as prescribe[i]; it is evident that this reminder system could have a significant impact on medication adherence and disease management.

Just before Mavis begins her Google search for a gift she wants to purchase for her granddaughter using her home monitoring tablet, an alert comes up reminding her of her appointment during the week with the podiatrist. She checks her calendar. She is grateful for the reminder as she has a tendency to forget some of her appointments as there seems to be so many she needs to keep track of, but this system has helped her to attend these.

downloadHow does it work?

The remote monitoring solutions on the market in Australia, such as those from Tunstall[ii] and Telstra[iii], provide the client with an internet enabled large screen tablet that is pre loaded with the monitoring platform. The device at the consumer end also come with blood glucose meters, thermometers, BP monitors, pulse oximeters and scales that are Bluetooth enabled to allow the information to be automatically upload to both the patients and caregivers portals. These tablets also support video conferencing and some allow the use of the patients own devices such as personal trackers to be uploaded as well as manual data entry where devices are not Bluetooth enabled. Most units on the market provide access to internet and email servers making them more than simply a health monitoring device, but connecting their owners to the online world.

Checking the patient information at the other end are usually community care provider organisations such as the RDNS and Silver Chain that have developed a clinical care team to respond according to their clients individually set parameters. Intervention may be set to occur if medications are not taken by a set time or if monitoring parameters are out of the individuals set target range. The targets and trigger points for intervention are individualised. Some monitoring systems allow the information (where appropriate permissions have been sought) to also be shared live with other health care professionals and integrate into their existing and varied software programs.

What is the evidence this technology helps?

Remote monitoring is not new to Australia with some of the early trials being run in Queensland in areas where the NBN has been made available. The trials of this technology have been, for the most part, successful with improvements seen in HbA1c and overall satisfaction with the management of their condition. A recent Parliamentary inquiry into telehealth demonstrates improved patient satisfaction and quality of care in many of the programs introduced in Queensland.[iv]

A system similar to those utilised in Australia was researched and published by the US team at WellDoc, demonstrating that through remote monitoring and timely clinical interventions, reductions of HbA1c of 1.9% over 12 months could be achieved[v].

Conclusion:

Achieving optimal and personalised outcomes is enhanced by regular and timely education interventions and engagement at opportunistic moments in the person’s health care journey. Remote monitoring with telehealth intervention appears to be a perfect fit for people with chronic disease such as diabetes, to not only live safely at home but to improve self management of their condition as it is easy to use and provides timely support as required.

The use of remote monitoring with telehealth will undoubtedly continue to grow if connectivity across all areas of Australia is supported and if costs of the service are contained. If this happens, people living with diabetes and other chronic diseases could be provided with another tool to assist with putting them in control to improve their health outcomes no matter where they live in our vast continent.

References:

[i] https://www.monash.edu/pharm/current/step-up/clinical-roles/med-adherence

[ii] http://www.tunstallhealthcare.com.au/solutions/chronicdiseasemanagement

[iv] http://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2014/5414T5969.pdf

[v] Quinn, C et al, Cluster and Randomized Trial of Mobile Phone Personalised Behavioural Intervention for Blood Glucose Control.  Diabetes Care September 2011 34:9 1934-1942

 

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