COMPETITIVE AINEC RESEARCH AWARD
MANUSCRIPT
AINEC RESEARCH AWARD
TELEHEALTH FOR SELF MANAGEMENT IN CHRONIC DISEASES
Researchers:
Ns. Putu Oka Yuli Nurhesti, S.Kep., MM., M.Kep NIDN.0530078001
Ns. Made Oka Ari Kamayani, S.Kep., M.Kep NIDN. 001888018306
SCHOOL OF NURSING, FACULTY OF MEDICINE
UDAYANA UNIVERSITY
ABSTRACT
TELEHEALTH FOR SELF MANAGEMENT IN CHRONIC DISEASES Putu Oka Yuli Nurhesti, Made Oka Ari Kmayani
The development of information technology is getting better. It can help to improve the quality of nursing care in patients with chronic disease. Innovation and social engineering in the field of health care with the empowerment of patients and their families is one of information technology products in the field of health to help patients perform the management of the chronic diseases. Telehealth is a method to provide information related to self management in patients with chronic disease with the help of communication tools and social media. Telehealth method goal is to help patients with chronic diseases controlling the disease through self-management. The models used in this study is the Chronic Care Model (CCM). The tool for measuring patient’s self management is Patient Activation Measure (PAM).
This research is quasy experiment conducted in patients with chronic disease in Sanglah Hospital Denpasar. The sampling technique used is purposive sampling with randomization to divided respondents into control and treatment groups. Telehealth method was applied to perform discharge planning for patients with chronic diseases who were treated at Sanglah Hospital. The discharge follow-up conducted by telephone and short message twice a week for theree weeks. Patient self-management assessed either in the control group or treatment with a questionnaire translated instrument of PAM. The process of validity and reliability test performed by the test content and back translation method.
The results show a significant difference between the self-management of patients with chronic diseases who gets telehealth follow-up and with chronic disease patients who do not get telehealth follow-up with an average PAM score of 75.6 ± 10.4 in the treatment group and 62.5 ± 10.0 in the control group. The value of independent t-test with a 95% confidence level is 0.001. This value is smaller than 0.05
Telehealth can help patients with chronic diseases to improve self-management and active involvement in the control of their chronic condition
INTRODUCTION
Technological and social innovation in health care is one way to make the self management of various chronic diseases. Adult nursing technology is growing rapidly in many parts of the world, as part of the development of science and technology in general. Countries in the world have started to do research on nursing technology use in the prevention and management of disease. Indonesia as one of the developing countries have not optimally developed technology of nursing in the prevention and management of diseases, especially chronic diseases. Chronic disease is a condition in which an individual suffering from a disease that is not curable but can be controlled. According to WHO (2010), which includes chronic diseases are heart disease, stroke, Chronic Obstructive Pulmonary Disease (COPD), cancer, hypertension, diabetes and kidney disease. Chronic diseases have various influences on physical function, psychological, economic, social and spiritual. The disease is generally followed by a variety of chronic conditions such as pain, disability, and limitations of function as well as psychosocial issues that influence the quality of life of patients (CDC, 2006). Chronic diseases require the active participation of the patient and family for controlling and managing the disease throughout the life.
Self-management is the dynamic, interactive, process where the patient is actively involved in the control and management of the disease. Self-management refers to the ability of individuals (patients) to work with families, communities, and health care providers to manage the symptoms of the disease, therapy, lifestyle changes, and the consequences of psychosocial, cultural and spiritual related disease conditions (Richard & Shea, 2011), The use of medical technology and nursing in the treatment of patients with chronic diseases is essential to help patients controlling the disease through self-management. Telehealth is one way to facilitate patient self-management using the nursing and medical information technology in the form of telephone, SMS and social media use. According to Locsin, 2005, an important nursing technology was developed to support the delivery of nursing care.
LITERATURE REVIEW
Chronic disease is defined as a medical condition or health problems associated with the symptoms or disability requiring long-term management. Part of this management involves learning to live with this disease and disability that might occur, and modify lifestyle to control the signs and symptoms. This disease can be suffered by all age groups, socio-economic and cultural level. Examples of common chronic diseases: chronic sinusitis, arthritis, hypertension, heart disease, chronic bronchitis, asthma, diabetes, chronic kidney disease (Falvo, 2005; Smelthzer Bare, Hinkle, Cheever, 2010). According to WHO (2005), which includes chronic diseases are heart disease, stroke, respiratory disease, cancer and diabetes mellitus.
According Oeffinger, Mertens & Sklar, (2006), the cause of the growing number of people with chronic diseases are: 1) The decline in the death rate from infectious diseases for example measles, diphtheria, infections associated with HIV / AIDS, and good management of various acute conditions such as trauma; 2) Lifestyle factors such as smoking, chronic stress, and monotonous lifestyle that enhances the risk of chronic health problems such as respiratory disease, hypertension, cardiovascular disease and obesity. Although the signs and symptoms of chronic disease often appears first in adulthood but the progression of the disease may have been started since the age of the children; 3) Increased life expectancy as a result of advances in science and medical technology, improved nutritional status, working conditions safer, and easier access to health services; 4) Increased screening and diagnostic procedures so that early detection and disease management can be done and improve yield management and treatment of various chronic diseases
Self-management model has been developed to provide a frame of reference in providing self-management techniques in patients with chronic disease. Chronic Care Model (CCM) is a model that is evidence based integrated of health knowledge by prevention, treatments, diagnosis, monitoring and controlling chronic diseases in order to achieve outcomes related to optimal quality of life for patients with chronic diseases (Epping-Jordan et al 2004). This model considers that self-management can improve clinical and functional outcomes of patients, disease management through productive interaction between information providers, liveliness and readiness of patients, health professionals proactive team with the support of a good information system.
According to Harvey, (2006); Popoola, (2005) some of the factors that influence self-management in individuals with chronic diseases have been identified: 1) Demographic factors: These factors include socioeconomic and cultural status; 2) clinical factors: morbidity, mortality and the degree of complexity of the clinical condition of the patient; 3) system: these factors include the quality of the relationship and communication with health care providers. Measurement of the ability of self-management of patients with chronic disease can be done with a variety of measuring instruments, including the Patient Activation Measure (PAM), which is a measurement tool to assess the knowledge, confidence levels and the ability of the patient in self-management. This instrument consists of 22 questions grouped into three components, namely: believe in the importance of active involvement, confidence and knowledge of actions related to self-management, the act of self-management, the ability to maintain self-management in conditions of stress (Hibbard & Tusler, 2007; Lieberman, 2003). ,
According to The Picker Institute Europe, 2005, interpretation PAM score is as follows: Stage 1: the trust of patients to the importance of the roles, PAM score of 47.0 or less; Stage 2: the confidence and knowledge to take action PAM score of 47.1 - 55.1; Stage 3: take action PAM score of 55.2 - 67.0; Stage 4: keep doing self management even under stress or pressure PAM score of 67.1 or more.
Telehealth is the use of information technology in providing health care to patients. Telehealth may include the use of information technology by various health professionals including doctors and nurses. Information technology in the field of nursing is an information technology that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information, and knowledge to support clients, nurses, and other health care providers (Moscato et al. 2007; Fitzner & Moss, 2013).
the patient can be a barrier to effective communication between nurses and patients; 2) Skill of collaboration: the ability to collaborate in a team of nurses to patients, families and other health professionals will support the implementation of telenursing and ensure adequate flow of information to the patient; 3) Clinical skill assessment: a nurse who do clinical telenursing are required to have the ability to recognize various emotional changes, physical changes that occurs in patients to provide effective treatment for acute conditions; 4) Skill related to information technology: the nurse who did telenursing must have a mind and an open attitude towards the development of information technology.
Self-management with telenursing method is a method that integrates the concept of self-management with the help of technology onformasi and carried out by nurses. This method is widely used in helping patients with chronic diseases to the management of the disease through lifestyle changes. Chronic disease with a variety of characteristics such not curable condition, require control throughout a patient's life, there is a period between the acute and chronic conditions that need the stress management and social support .
Research conducted by Nilsson (2009) on the use of SMS to medication adherence in chronic disease patients in the district perawa in Sweden, shows there is increased confidence in nurses and patient adherence to therapy protocols. Research conducted by Solomon (2008), Knight & Shea (2014) showed that there was significant relationship between self-management, patient characteristics and the use of technology. Telenursing increasing the capability of nurses to provide a variety of information related to self management in patients with chronic diseases such as; nutrient management, protocol therapy, social support and stress management.
RESEARCH METHODS
RESEARCH PROCESS
This study began with the preparation, implementation and final. Preparation is done by applying the test of ethics and conduct trials, asking application letter and permit research to the research and development Sanglah Hospital, Faculty of Medicine, University of Udayana. Randomization was performed to include respondents who met the inclusion criteria into control and treatment groups according to the return from the hospital. Patients given inform concern then performed 3 times a week telephone and SMS for 3 weeks. Phones given to the treatment by the investigator (nurse) and in cooperation with the treating physician resident. After 3 weeks of either the control or the treatment group was given questionnaires to assess PAM Score. There were 3 patients in the treatment group dropped out due to a decrease in health conditions and 5 respondents in the control group whose address is hard to find and a decrease in health conditions.
Researchers have considered the ethical principles in performing any action or intervention in this study and all activities performed on a patient using the clear informed consent. Before the study began made ethical ethics clearance through a test conducted by the research ethics committee FK unud / Sanglah Hospital in Denpasar, so this study considering the ethical principles like beneficence, Respect for human dignity, Justice.
RESULT
The age of patients suffering from chronic diseases are above 30 years and in both groups of patients with highest number of patients is in the age range 31- 40 years, although in the treatment group as well as large number of respondents in the age range 71-80 years. Falvo, (2005); Smelthzer Bare, Hinkle, Cheever, (2010), state that chronic diseases can be suffered by all age groups socioeconomic and cultural level. According Oeffinger, Mertens & Sklar, (2006), the epidemiological transition has changed the course of various chronic diseases, where chronic diseases appear at an increasingly young age due to various causes including lifestyle factors. In the control group of chronic disease affects more men than women are respectively 16 cases (53.3%) and 14 cases (46.7%). The results of this research together with research conducted by Ndraha, Rinaldi, Hernando and Santosa (2010 ) conducted in Koja Hospital Jakarta, where the number of patients with chronic diseases more men than women are 30 (54.5%) men and 25 (45.5%) women. The number of patients in the treatment group more women than men, respectively 13 men (43.3%) and 17 women (56.7%). According to Smeltzer, Bare, Hinkle, Cheever (2010), a chronic disease can occur at any age and gender.
disease, and the rest is a combination of various diseases. According to Clarke & Currie, (2009), the emergence of chronic disease will be followed by the emergence of other chronic diseases in the same individual, so many individuals are not only suffered with one type of chronic disease. In this research can be seen there are patients who suffer from more than one chronic disease, it is likely due to a chronic disease is a predisposition of the other chronic diseases, for example diabetes mellitus predisposes to the appearance of hypertension, CKD and stroke due to increased blood viscosity due to high levels of glucose blood.
Self-management level with a score of PAM, most respondents in the group that did not do telehalth are at stage 3 is taking action with PAM score of 55.2 - 67.0. At this stage the patient is able to take action if there are conditions that occur related acute illness, for example subtracts the current salt intake is known to increase blood pressure in patients with hypertension. In patients with chronic disease self-management level given telehealth with PAM scores, the majority of respondents were in stage 4 is still perform self management even under stress or pressure PAM score of 67.1 or more. At this stage the patient remains capable of controlling the disease is continuously consistently in various situations. Hypertensive patients remains a diet low in salt even though her blood pressure was stable or under pressure from a variety of social situations. This research was supported by the results of research conducted Solomon (2008) where the use of information technology can improve the ability of self-management in patients with chronic disease. Results of other studies that support this research which scores menilaib PAM used for self management in patients with chronic disease carried Greene and Hibbard (2012); Hibbard et al (2005), by providing information over the telephone and audiovisual in society who are at risk of chronic disease suggests there is an increase PAM scores for screening the disease in an individual.
According to Harvey, (2006); Popoola, (2005) some of the factors that influence self-management in individuals with chronic diseases have been identified, namely: Demographic factors: These factors include socioeconomic status and cultural, Clinical factors: morbidity, mortality and the degree of complexity of the clinical conditions of patients, Factor system: factor This includes the quality of the relationship and communication with health care providers. This study uses a system factor of effective communication between patients and health provider to provide information on patients with chronic diseases of various patients with the necessary control and social support expected.
Mann Whitney test results demonstrate the value of p = 0.001 where the value is smaller than 0.05 so there is a significant different of (significant) self management in patients with chronic disease were given telehalth by phone and SMS and chronic disease patients who were not given telehealth. Results of this research together with research conducted by McCabe et al (2014), in which there is an increase in self-management knowledge, and ability to support rehabilitation in patients with chronic lung disease after being given information about the management of the disease. Research of Chiang et al (2012) showed that there is an increased ability of stress management, family involvement and confidence in patients with chronic disease given telehealth method that given as a follow-up after discharge of patients from hospital. Research Sharma and Clark (2014) suggests that telehealth service delivery with support of nurses who provide care to patients with chronic diseases as a new method in the delivery of nursing care.
According Dabb et al (2013) of the patients and families are the main systems that help individuals with chronic disease to manage themselves to controlling the disease. Effective self-management requires the active involvement of patients to make lifestyle changes and remain consistent to do so even in a stable condition or under a certain pressure. Acording to Russel (2012) nursing technology capable of supporting the provision of nursing care to be effective and efficient as well as making an important decision in nursing to improve the various outcomes in the treatment of patients with chronic diseases.
Patients with chronic diseases were treated at Sanglah Hospital in Denpasar, most have suffered from chronic diseases over 2 years. Knowledge about the illness is quite good. The desire to control the disease have consistently not been so good in patients with chronic disease were not given telehealth, where the average value of PAM is 62.6. Patients with chronic diseases are given methods of telehealth has knowledge as well as the desire to consistently control the chronic disease experienced by the average value of PAM 75.5. Almost all patients with chronic diseases very cooperative receive calls and SMS answer from researchers. Many questions they asked and they want to get information about the illness. This is probably because the patients who went to Sanglah Hospital is the referral of patients who have long exposed about the disease. Besides, discharge planning have been started by the nurses and doctors who deal even though the information provided there is not yet optimal according to the needs of the patient.
CONCLUSIONS AND SUGGESTIONS
phone and SMS and chronic disease patients who were not given telehealth. Telehealth method by using phone and SMS is a method that can be used to enhance the ability of self-management in patients with chronic disease. This method can be applied as part of the patient discharge planning as a method of continuous treatment to control the disease. Further research on self-management methods need to be performed with the telehealth control some of the factors that affect the self-management strictly. Further research can be done by adding variables such as the number of hours phoning penialian effective, recurrence or complications that could be prevented as well as costs incurred
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