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Effects of e-Health to Maintain Health Among Older Adults with Congestive Heart Failure (CHF): Randomized Controlled Trial. Machiko R. Tomita, Ph.D. Department of Rehabilitation Science University at Buffalo Presented at NYSOTA Conference Buffalo, NY September 27-29, 2007
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Effects of e-Health to Maintain Health Among Older Adults with Congestive Heart Failure (CHF): Randomized Controlled Trial Machiko R. Tomita, Ph.D. Department of Rehabilitation Science University at Buffalo Presented at NYSOTA Conference Buffalo, NY September 27-29, 2007 Funded by the National Institute of Aging
What is e-Health? • eHealth is a method utilizing emerging interactive technologies to address the limited capacity of the health care system to provide health behavior change and chronic disease management interventions. - Health e-Technologies Initiative Ahern, D., Kreslake, J., Phalen J. What is eHealth: Perspectives on the evolution of eHealth research. J. Med Internet Res 2006;8(1):e4
What does “the limited capacity of the health care system” mean and why older adults? • Increase in the number of older adults: 36.3 million in 2004 (12.4%) and 55 million in 2020 (16.4%). Administration on Aging. A profile of Older Americans 2005 • Of the more than half-million licensed physicians practicing in the US, fewer than 9,000 have met qualifying criteria in geriatrics--which amounts to roughly 1 geriatrician to every 4,000 older adults presently. American Medical Directors Association, 2005 • 55-65 is the fastest growing segment for Internet use.
Background • Telemedicine: health care provides to monitor patients progress for a short period of time. –VA, VNA, • E-health research: Type 2 Diabetes • Limited use of e-health • Short period • Intervention was provided without knowledge of behavioral change • Identification of users
Major Symptoms of CHF • Edema • Legs and ankles • Abdomen • lung • Dyspnea • Fatigue • Depression • Weight gain
Treatment for CHF • Medicationsto help remove fluid such as diuretics or to make the heart work better such as beta blockers, vasodilators, etc. • Dietary modifications, such as reducing salt , water, and cholesterol intake • Lifestyle changes, such as smoking cessation, alcohol intake limitation • Exercise • Health Behavior Change Support using e-health
Why CHF ? • Prevalence: 5.0 million Americans (1.8%) 40-59- 2%, 60-69- 5%, 70 + -10% • New CHF cases: 550,000 • Death: 300,000/year • On average, patients die within 5 years • Hospitalization rates: the leading diagnosis-related group (DRG) among hospitalized patients older than 65 years. Approximately 30-40% of patients with CHF are hospitalized every year. Readmission rates:50% • Approximately 5-10% of hospital costs • Health care cost for CHF: $38.1 billion . Source: The National Heart, Lung, and Blood Institute (NHLBI)
Purpose of the Study • The purpose of this study was to conduct a pilot study with a randomized controlled trial to change CHF patients’ health behaviors through use of e-health providing four types of support: Instrumental, informational, emotional, and appraisal.
Conceptual Model: Social Network and Social Support,Transtheoretical Model, & Uses and Gratifications E-health Instrumental Support Personal Factors Appraisal Support Informational support Emotional Support Precontemplation contemplation Preparation Action Maintenance Family andFriends
Use of E-health in the Study Informational support for knowledge • Created a public website with tailored CHF and health activity information in a senior friendly format with quiz. www.agingresearch.buffalo.edu
Use of E-health in the Study Instrumental support for monitoring health • Created a secure website for daily record of vital signs and health activities in a short form that can be woven into a daily routine .http://dailyhealthlog.info • BP/pulse, and weight • Medication compliance • Dietary and Alcohol intake, and Smoking • Types of and Amount of Exercise • Swelling and fatigue • Health change from the previous day
Use of E-health in the Study Appraisal support for assurance • Regular feedback and reinforcement of health status from a health professional team via e-mail and telephone. Emotional Support Next presenttation
Research Questions 1. Do patients with CHF use e-health, when e-health technology is available? 2. Do patients with CHF gain relevant knowledge when they use e-health technology? 3. Do patients with CHF engage in healthy behaviors when they use e-health technology? 4. Do patients with CHF maintain their health/function/QoL better when using e-health technology? 5. What is the outcome of healthcare utilization? 6. What are the subjective opinions regarding e-health use?
Differential Expectation Symptoms Health care utilization Control Treatment Time Home-based NH Death
Methods-Study Design Randomized controlled repeated measures design with the intervention duration of 18 months. * This presentation is at the 12th month.
Methods - Subjects • Inclusion criteria: NY Heart Association Classification of 2 or 3 and past record of hospitalization or emergency visits due to CHF. • Sample size: 16 each for Treatment and Control. Due to a higher attrition rate, 24 were recruited for the control group. • Convenience sampling method was used to recruit participants from 3 hospitals and 2 HMOs in WNY.
Methods - Procedures • Random assignment of participants. • Interview at participants’ home. • Health behavior goal set • Notification to the primary physician • Step by step patient training • For Treatment group, provision of BP monitor, pedometer, bath scale, computer with Internet connection, desk, chair, and lamp were provided • Computer training. • 2 websites introduction. • Introduction of tailored exercise protocol. www.agingresearch.buffalo.edu
Methods - Procedures • Regular feed back for their health behavior record from a health professional team. • E-mail and phone contact for consultation and encouragement • Control group, monetary compensation.
Result : RQ1. Use of e-health • Use of e-health technology • 100% of treatment people went to the publicly available web site at least once a month. M=3.5 times/month • 100% of treatment people recorded their health activities in the secured website. • On average, 85% of 355 days • Reason for nonuse was not staying home (visit family, went to FL, a hospital or rehab facilities).
Result: RQ 2. Knowledge Gain Knowledge question: 20 items ( 0 – 55 )
Result: RQ 5. Healthcare Use and Living Status • Above Cramer’s V = .356 (p=.409) • Left Cramer’s V= .443, (P=.020)
Result: RQ 6. Evaluation of e-health • How much did you learn about healthy behaviors? A lot84.6% Some15.4% • How satisfied are you with the program? Very much 84.6% Somewhat 15.4% • How is your CHF condition compared with one year ago? Better 92.3%Same 7.7% • How helpful was it for you to do the exercises? Helpful 92.3% Not much 7.7% • How confident are you in dealing with CHF due to the program? Confident 100% • Do you recommend this program to your friend with CHF? Yes100% • Which part did you like most? Monitoring myself for increased awareness (4) Improved health (3) Support/people (3) Exercise (2) Computer use (1) Website (1) • Which part did you dislike most? Exercise when I don’t feel like doing (1) Entering data of exercise part (1) None (11)
Summary and Conclusion • Successful • Health behavior change occurred and was sustained due to patients’ heightened awareness of their own health behaviors and confidence in managing illness. • Reasons • Interventions were guided by theories and implemented strategically in every step. • Contribution • The social network and social support theory was extend to technology use • E-health can be effective among older adults, if feedback is available from a health care professional.
