Development and evaluation of a patient-oriented education system for diabetes management
Introduction
Diabetes is an irreversible disease requiring lifetime care and rehabilitation. Persistent monitoring and control of blood sugar levels are effective treatments [1], [2], [3], [4], whereas consistent patient education to improve their ability in administering self-care is also effective, lowering the risks of developing complications [3], [5], [6], [7], [8], [9], [10]. In Taiwan, traditional patient education as well as follow-ups requires patients to return to the hospitals where they received their medical care. In order to encourage patient participation, most education activities operate in conjunction with follow-up clinics [11], [12], [13].
As the Internet becomes more widespread, the general public is beginning to seek medical information and support online [13], [14], [15], [16]. There are currently many Web sites providing general information on diabetes, its treatments, and knowledge and skills of self-management [17], [18]. However, most patients require more specific information regarding their individual disease conditions. Therefore, it is hardly possible for them to obtain appropriate and adequate education from the Internet without the help of clinical professionals [19], [20], [21].
In recent years, many researchers have used computer programs and Web interfaces [22], [23], [24], [25], [26], [27], [28] to provide frequent and responsive interactions between patients and their physicians online. The online services can motivate patients to utilize the systems more enthusiastically, leading to the better management of their diabetes conditions.
Patient education is usually an important component in routine medical services. After being evaluated and receiving instructions from their doctors at a hospital visit, a patient can receive an individual tutorial along with education materials (such as goals to achieve, and knowledge and skills for self-management) based on the development of their disease conditions. To extend this highly individualized patient education for a lasting effect, such tutorials and education materials should be presented on the Web so patients can easily access the information after having left the hospital.
A high percentage of the population in Taiwan use the Internet (about 61%) [29]; thus, dissemination of health care information through it is becoming increasingly popular. An Internet questionnaire survey on information provided by medical care services most concerned by patients showed that the top two were: completeness of their medical care data and comprehensive explanations for their prescribed medicines [30]. Based on these needs, we have developed a patient-oriented education management (POEM) system for extending the routine patient education service [31].
In the system, we collect diabetic patients’ medical care data along with their education materials at each hospital visit and organize them into educational folders, then present the structured folders on the Web. This paper is organized into six sections presenting: a brief description of the POEM system in Section 2; the method for evaluation of the system in Section 3; the results shown and discussed in Sections 4 Results, 5 Discussion; followed by conclusions in Section 6.
Section snippets
System description
The POEM system, as shown in Fig. 1, consists of the following major components: Web browsers for patients; a patient-oriented medical care data organizer (POMDO) for consolidating an individual's medical care data in a hospital; a Web server as repository and service provider for patients’ medical care information and education materials.
The POMDO is used to retrieve a patient's medical care data from hospital information systems at each visit and organize them into a folder for that visit.
Study design
A quasi-experimental study that uses control groups and pretests was used to evaluate the outcomes of the system intervention. The target population of this study was the patients with type-2 diabetes who visited the Metabolism Center at TMUWFH. In addition, the patients must meet the following conditions:
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Did not have any severe complications that would affect the patients’ ability to follow physician's orders, for example, blindness, stroke, or amputation;
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Had a normal level of consciousness
The characteristics of participants
The total number of participants in this study was 274: 134 (57% males and 43% females) in the intervention group and 140 (46% males and 54% females) in the control group. Their characteristics are shown in Table 1. The age and durations of diabetes of the intervention and control group were 61.2 ± 12.7 and 66.0 ± 8.5 years and 5.28 ± 4.70 and 7.01 ± 5.44 years, respectively.
The patients with a college or university degree were the majority: 38.8% in the intervention group and 38.6% in the control
Discussion
Diabetes mellitus is a complex chronic metabolic disease. Without appropriate treatment, complications such as cerebrovascular and coronary heart disease, nephropathy, retinopathy, and gangrenous foot often occur [1], [2]. Persistent and continued patient education can effectively help patients control blood glucose and HbA1c levels and delay the occurrence of associated complications [7], [10], [11], [32]. In our approach we collect and integrate a diabetic patient's medical care data and
Conclusion
We take advantage of Web technology to extend hospital patient education services by integrating patients’ medical care data into their education program components and presenting them on the Web. Since most patients are concerned about their medical care data, the POEM system can provide the incentives to motivate patients to continuously and persistently log in and learn their required knowledge and skills, prolonging the effect of patient education after they have left the hospitals. The
Acknowledgments
This research was partially supported by the grants from the National Science Council (NSC92-2516-S-038-002) and the Taipei Medical University Wan-Fang Hospital (93TMU-WFH-25).
References (37)
- et al.
Development and evaluation of an integrated pharmaceutical education system
Int. J. Med. Inform.
(2004) - et al.
Evaluation of the quality and contents of diabetes mellitus patient education on Internet
Patient Educ. Counsel.
(2004) - et al.
DiasNet—a diabetes advisory system for communication and education via the internet
Int. J. Med. Inform.
(2001) - et al.
The D-Net diabetes self-management program: long-term implementation, outcomes, and generalization results
Prev. Med.
(2003) The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin-dependent diabetes mellitus
N. Engl. J. Med.
(1993)Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)
Lancet
(1998)- et al.
Diabetes care and patient-oriented outcomes
J. Am. Med. Assoc.
(1999) Standards of medical care for patients with diabetes mellitus
Diab. Care
(2003)- et al.
An outpatient model of integrated diabetes treatment and education: functional, metabolic, and knowledge outcomes
Diab. Educ.
(1994) Diabetes self-management education
Diab. Care
(1995)
Improvement in diabetic care as measured by HbA1C after a physician education project
Diab. Care
Diabetes self-care knowledge among outpatients at a Veterans Affairs medical center
Am. J. Health Syst. Pharm.
Readiness to change and clinical success in a diabetes educational program
J. Am. Board Fam. Pract.
Improving quality of life in diabetes education: how effective is education
Patient Educ. Counsel.
Evaluation of a structured teaching and treatment programme for type 2 diabetes in general practice in a rural area of Austria
Diab. Med.
Interventions to improve the management of diabetes in primary care, output, and community settings
Diab. Care
Internet as clinical information system: Application development using the World Wide Web
J. Am. Med. Inform. Assoc.
The cardiology beat: an Internet education for patients and health professionals
J. Am. Med. Assoc.
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